| Home | Free Articles for Your Site | Submit an Article | Advertise | Link to Us | Search | Contact Us |
This site is an archive of old articles

    SEARCH ARTICLES
    Custom Search


vertical line

Article Surfing Archive



Managing Evidence-Based Self-Insurance Plans - Articles Surfing

Instead of contracting with a traditional health insurer to provide group health insurance, many organizations are turning to self-funded insurance plans that are managed by third-party administrators or an outside health management company. According to the Employee Benefit Research Institute (EBRI), about 50 million workers are covered with self-insured group health plans. To help reduce costs and errors associated with these plans, many of these entities are now evolving into 'evidence-based' self-insurance plans.

Because self-insured plans are subject to the Employee Retirement Income Security Act (ERISA)'the federal law that protects employees' retirement income and benefits'the same rights that are available to insureds with traditional healthcare plans are available to individuals on a self-insured corporate plan. This means that when treatments are denied, for whatever reason, the patient has a right to appeal the decision and have it reviewed by a like specialist not involved in the original claims decision. When such a dispute arises, TPAs and self-funded insurance managers are required, by ERISA and state laws, to have questionable cases reviewed by non-biased specialists within specific timeframes.

The primary issue here is how do the management companies, without a full medical panel on staff, decide that treatment decisions are based on proven medical evidence each and every time? How do these companies ensure that they are staying up-to-date with the latest medically approved treatment options?

While some cases are obvious, partnering with an Independent Review Organization (IRO), such as AllMed Healthcare Management, may be just the answer to this issue. An IRO can provide access to the broadest panel of specialists that can make sure decisions are based on proven medical evidence. And, an IRO can also help guarantee state and federal deadlines are met by turning around review decisions within 48 hours or less. For more information on how an IRO can help your organization, please contact AllMed at 800-400-9916.

Submitted by:

AllMed Healthcare Management

AllMed Healthcare Management Founded in 1995, AllMed (http://www.allmedmd.com, http://www.allmedmd.com/blog/index.htm) is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers.

info@allmedmd.com



        RELATED SITES






https://articlesurfing.org/health/managing_evidencebased_selfinsurance_plans.html

Copyright © 1995 - Photius Coutsoukis (All Rights Reserved).










ARTICLE CATEGORIES

Aging
Arts and Crafts
Auto and Trucks
Automotive
Business
Business and Finance
Cancer Survival
Career
Classifieds
Computers and Internet
Computers and Technology
Cooking
Culture
Education
Education #2
Entertainment
Etiquette
Family
Finances
Food and Drink
Food and Drink B
Gadgets and Gizmos
Gardening
Health
Hobbies
Home Improvement
Home Management
Humor
Internet
Jobs
Kids and Teens
Learning Languages
Leadership
Legal
Legal B
Marketing
Marketing B
Medical Business
Medicines and Remedies
Music and Movies
Online Business
Opinions
Parenting
Parenting B
Pets
Pets and Animals
Poetry
Politics
Politics and Government
Real Estate
Recreation
Recreation and Sports
Science
Self Help
Self Improvement
Short Stories
Site Promotion
Society
Sports
Travel and Leisure
Travel Part B
Web Development
Wellness, Fitness and Diet
World Affairs
Writing
Writing B