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Frequently Asked Questions


What is an MCO?
When should I call SMAI/BWC?
My claim is in the $15K Program. What does that mean to me?


What is an MCO?

A Managed Care Organization (MCO) is a private company that an employer contracts with to medically manage the workers compensation claims for injured employees. An MCO will work with the employer, injured worker and provider to ensure a safe and quick return to work and to minimize costs.

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When should I call SMAI or the BWC?

You should call the BWC with any questions about your claim allowance or questions about payment for lost time from work. You should call SMAI for all other questions.

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My claim is in the $15K Program. What does that mean to me?

While your claim is enrolled in the $15K program, your employer is responsible for paying all medical and pharmacy bills up to the first $15,000 of medical costs. If you receive a bill, then give it to your employer. You also do not need prior authorization for treatments related to your injury.

Once your claim reaches the $15,000 limit or if your employer opts your claim out of the program, SMAI will start to medically manage your claim and pay the medical bills. Once SMAI starts managing the claim, you will need prior authorization for treatments

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Spooner Medical Administrators, Inc. | 28301 Ranney Parkway | Westlake, Oh 44145 | Main: 440.899.2400 | Toll-Free: 800.542.9479 | Fax: 440.899.2411