| Instead of contracting with a traditional | | | | TPAs and self-funded insurance managers are |
| health insurer to provide group health | | | | required, by ERISA and state laws, to have |
| insurance, many organizations are turning to | | | | questionable cases reviewed by non-biased |
| self-funded insurance plans that are managed | | | | specialists within specific timeframes. |
| by third-party administrators or an outside | | | | |
| health management company. According to the | | | | The primary issue here is how do the |
| Employee Benefit Research Institute (EBRI), | | | | management companies, without a full medical |
| about 50 million workers are covered with | | | | panel on staff, decide that treatment |
| self-insured group health plans. To help | | | | decisions are based on proven medical |
| reduce costs and errors associated with these | | | | evidence each and every time? How do these |
| plans, many of these entities are now | | | | companies ensure that they are staying |
| evolving into "evidence-based" self-insurance | | | | up-to-date with the latest medically approved |
| plans. | | | | treatment options? |
| | | | |
| Because self-insured plans are subject to the | | | | While some cases are obvious, partnering with |
| Employee Retirement Income Security Act | | | | an Independent Review Organization (IRO), |
| (ERISA)-the federal law that protects | | | | such as AllMed Healthcare Management, may be |
| employees' retirement income and benefits-the | | | | just the answer to this issue. An IRO can |
| same rights that are available to insureds | | | | provide access to the broadest panel of |
| with traditional healthcare plans are | | | | specialists that can make sure decisions are |
| available to individuals on a self-insured | | | | based on proven medical evidence. And, an IRO |
| corporate plan. This means that when | | | | can also help guarantee state and federal |
| treatments are denied, for whatever reason, | | | | deadlines are met by turning around review |
| the patient has a right to appeal the | | | | decisions within 48 hours or less. For more |
| decision and have it reviewed by a like | | | | information on how an IRO can help your |
| specialist not involved in the original | | | | organization, please contact AllMed at |
| claims decision. When such a dispute arises, | | | | 800-400-9916. |