Managing Evidence-Based Self-Insurance Plans

Instead of contracting with a traditional healthTPAs and self-funded insurance managers are
insurer to provide group health insurance, manyrequired, by ERISA and state laws, to have
organizations are turning to self-funded insurancequestionable cases reviewed by non-biased
plans that are managed by third-partyspecialists within specific timeframes.
administrators or an outside health managementThe primary issue here is how do the
company. According to the Employee Benefitmanagement companies, without a full medical
Research Institute (EBRI), about 50 millionpanel on staff, decide that treatment decisions
workers are covered with self-insured groupare based on proven medical evidence each and
health plans. To help reduce costs and errorsevery time? How do these companies ensure
associated with these plans, many of thesethat 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 theIndependent Review Organization (IRO), such as
Employee Retirement Income Security ActAllMed 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 rightsto the broadest panel of specialists that can make
that are available to insureds with traditionalsure decisions are based on proven medical
healthcare plans are available to individuals on aevidence. And, an IRO can also help guarantee
self-insured corporate plan. This means that whenstate and federal deadlines are met by turning
treatments are denied, for whatever reason, thearound review decisions within 48 hours or less.
patient has a right to appeal the decision and haveFor more information on how an IRO can help
it reviewed by a like specialist not involved in theyour organization, please contact AllMed at
original claims decision. When such a dispute arises,800-400-9916.