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Managing Evidence-Based Self-Insurance Plans

Instead of contracting with a traditionalTPAs and self-funded insurance managers are
health insurer to provide group healthrequired, by ERISA and state laws, to have
insurance, many organizations are turning toquestionable cases reviewed by non-biased
self-funded insurance plans that are managedspecialists  within  specific  timeframes.
by third-party administrators or an outside
health management company. According to theThe primary issue here is how do the
Employee Benefit Research Institute (EBRI),management companies, without a full medical
about 50 million workers are covered withpanel on staff, decide that treatment
self-insured group health plans. To helpdecisions are based on proven medical
reduce costs and errors associated with theseevidence each and every time? How do these
plans, many of these entities are nowcompanies ensure that they are staying
evolving into "evidence-based" self-insuranceup-to-date with the latest medically approved
plans.treatment  options?
Because self-insured plans are subject to theWhile some cases are obvious, partnering with
Employee Retirement Income Security Actan Independent Review Organization (IRO),
(ERISA)-the federal law that protectssuch as AllMed Healthcare Management, may be
employees' retirement income and benefits-thejust the answer to this issue. An IRO can
same rights that are available to insuredsprovide access to the broadest panel of
with traditional healthcare plans arespecialists that can make sure decisions are
available to individuals on a self-insuredbased on proven medical evidence. And, an IRO
corporate plan. This means that whencan 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 thedecisions within 48 hours or less. For more
decision and have it reviewed by a likeinformation on how an IRO can help your
specialist not involved in the originalorganization, please contact AllMed at
claims decision. When such a dispute arises,800-400-9916.



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