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