MCMC’s Medical Care Ombudsman Program (MCOP), established in 1992, is a national program that provides independent, objective, credible and cost-effective expert analysis to help clients make informed health care decisions.

To facilitate appropriate decision making, MCOP provides high-quality, timely reviews of complex cases in all domains of medicine and at levels of technology, assisting in prompt coverage of advisable treatments, avoiding unnecessary delays in starting medically necessary treatments and, identifying procedures that are not of proven benefit or that can threaten a patient’s length or quality of life.

Our products include:

• Case Reviews – evidence-based medical reviews, including expert advisory opinions, appeals of health plan coverage denials, and reviews of experimental or investigational treatments and medical necessity issues.

• Non-Case Reviews – expert analysis or evaluation that does not involve the medical care or health plan circumstances of a particular patient.

• State-Mandated External Reviews – independent reviews, analyses and evaluations of health plan coverage denials upon the request of state health or insurance departments.

• Medical Malpractice Consultations – thorough and timely case evaluation services and expert testimony that are ideal for actual or potential legal proceedings.

We also provide expert assessments and evaluations of medical technologies, practice guidelines (design management protocols, critical pathways and decision criteria) and research studies (scientific adequacy, soundness of research design and human research subject protection).

Among our clients are states, self-insured employers, health plans, provider organizations, benefit brokers, third party administrators, physicians, lawyers and patients.

More than 500 medical experts from across the country make up MCOP’s panel of reviewers. Generally, MCOP reviewers are board-certified physicians in active clinical practice with an academic medical center affiliation. Many have published extensively in peer-reviewed medical journals. In addition to physicians, our reviewers include dentists, medical social workers, nurse specialists, physiotherapists, psychologists and other health care practitioners. In addition, we have relationships with several centers of excellence to provide additional reviewers should they be needed. 

We provide 24-hour, 7-day-a-week service, as well as fast turnaround times, including express service oral reviews the next business day and written reviews within 48 hours and same-day or next-day emergency service. We provide rush reviews within 5 days and routine service within 14 days.

Backed by MCMC’s extensive knowledge of and dedication to continuous quality improvement, we provide the highest quality advisory opinions and expert reviews. We analyze the results of our CQI efforts to improve the design of our case review processes and the quality of our case reviews and service to our clients.

MCOP levels the playing field for patients, providers and payors when deciding coverage issues. We offer an enriched source of information to help our clients and other individuals make informed choices about specific medical interventions.

For more information on MCOP's extensive services, please call 888-313-6267, 301-652-1818 or e-mail mcman@mcman.com.