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