In Oregon, worker’s compensation is a system that covers medical treatment and wage replacement if you’re injured on the job. When it comes to acupuncture, the rules are pretty specific, especially if your claim is managed by Majoris Health Systems, which is a managed care organization (MCO) that works with many Oregon workers’ comp insurers. There are several worker’s comp insurance systems but all of them are similar in how they need to be handled in order for you claim to go through smoothly. The first step is to ask your worker’s compensation physician for a prescription/referral for acupuncture treatments from Mountain View Acupuncture. We will call on your injury claim and request treatments for you. If you would like to receive acupuncture as part of your recovery from your work injury, ask your doctor for a referral to Mountain View Acupuncture.

Here’s how it typically works:

Initial Injury and Claim Filing

  • You report the injury to your employer.
  • The employer files a claim with their workers’ compensation insurance.
  • If your employer is enrolled with Majoris, your claim will be managed through their network of approved providers. If it is not Majoris, we will call your adjuster directly for approval and pre-authorization.

Treatment Through Majoris

  • If your claim is accepted and Majoris is involved, you generally must treat with healthcare providers within the Majoris network unless you have prior approval for an out-of-network provider.
  • This includes acupuncturists — they must be enrolled or authorized under Majoris for your treatment to be covered.

Acupuncture Approval

  • Acupuncture can be covered under Oregon workers’ comp if:
    • The treatment is deemed medically necessary.
    • It is prescribed or referred by your attending physician.
    • The acupuncturist is part of the Majoris network or has received a special authorization: Mountain View Acupuncture is in Network with Majoris

Number of Treatments

  • There’s often a limit to how many acupuncture sessions are covered unless your doctor justifies the need for more.
  • Typically, the attending physician will need to submit treatment plans and updates to Majoris for ongoing approval.

Billing

  • The acupuncturist bills Majoris directly.
  • You should not have out-of-pocket costs for approved treatments.
  • Treatments need prior authorization or you could be responsible for the bill.