Trans4mind Home Page
~ A Journey of Self-Discovery ~

Explore Article Library

Getting the Most Out of Your IRO (Independent Review Organization)

By AllMed Healthcare Management

Working with an Independent Review Organization (IRO) is a bit like working with your physician. How do you know you're going to get the treatment to fix your ailment? Is the treatment covered by my insurance? How long do I have to wait for treatment? Have I given the doctor all of the information he or she needs to make the right care decision?

When requesting an independent medical review, careful consideration needs to be given to focusing on the specific issue(s) you're trying to resolve. Understanding what questions to ask in the first place will help keep costs at a minimum by ensuring your IRO is reviewing the proper records and facts and correctly delivering decisions on the issues at hand - the first time.

It's easy to confuse the issue of medical necessity of a procedure with the issue of whether or not a patient qualifies for that procedure according to your plan language. For example, say Mary Smith's doctor has referred her to a chiropractor for back pain treatment but the plan language on her policy does not cover chiropractic services - no exceptions. Regardless of medical necessity or the doctor's referral, the treatment would and should be denied. The IRO reviewer must be informed as to which issue you are trying to address up front.

Experimental and investigation treatments also pose a problem. Given constantly evolving technology, drugs and treatment protocols, it's often difficult to keep up with what's been approved as scientifically accepted treatment by the medical community and what's still considered experimental procedure. Knowing that the plan exclusions always take precedence over inclusions can save a lot of time in the review process. The plan language definition of experimental/investigational is central to the decision.

Following are some tips designed to make it easier for you to work with your IRO and ensure meaningful outcomes for both the patients and your business every time:

Make sure you isolate the specific issue you are trying to address before you develop your questions, such as standard of care, medical necessity, experimental/investigational and/or plan language interpretation.

Develop a list of questions that must be answered with a definitive and substantiated reason.

Make sure you include all relevant chart documents and plan language that are needed to provide a definitive response.

If you have exhausted your efforts to get the records you need for a review, a "no" response from your IRO may be just the stimulus needed to prompt the record holder to release the full documents.

Understand that it's your IRO's responsibility to call with questions or clarifications on independent medical review requests before they begin. Make sure your IRO understands who to call and the best time of day that person can be reached.

About The Author
AllMed Healthcare Management Founded in 1995, AllMed ( 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.


Careers & Employment
Grief & Loss
Kids & Teens
Public Speaking
Self Help
Self Improvement & Motivation
Sexual Relations
Stress Management
Travel and Leisure

From our extensive site, you'll find good info on many topics using this search:

Want to renew your life?

Our online, interactive video workshops present the most effective methods of holistic personal development...
Start off with a Free Life Assessment and a Free Consultation...

Have a question about Trans4mind Training?

Frequently Asked Questions
What Are Our Fees?
Email Peter Shepherd

Support your personal development with these popular and effective hypnosis downloads...

This is our selection of favorites, but there's a session for every need! Choose from over 800 Hypnosis Downloads...
Search now on an issue that interests or concerns you...

Welcome to the New Wave in Meditation Technology

Click here to learn more about the iAwake Profound Meditation Program
The iAwake Profound Meditation Program
is a way of enhancing your meditation practice, making meditation not only easier and more enjoyable, but also more efficient and effective.
Profound Meditation provides the smoothest, deepest, richest, most profound meditation experience available anywhere...
Here is a link to a free 20-minute track from iAwake Technologies - a sample of the type of tools that will deepen your meditation immediately and help you quickly become a successful meditator. It's the opening track of iAwake's flagship product, the Profound Meditation Program, called the iAwake Experience...
Learn More and Download the iAwake Experience
We think you'll find this technology a tremendous aid on your transformative journey of becoming your best and most creative self - and you can get started today!
And here's a fantastic resource for self-education...

The World of Inspiration eLibrary

World of Inspiration
A treasure trove of personal development wisdom

Step inside. Just like a real library, there are thousands of quality eBooks presented on three "floors" and in different "rooms." To purchase your $15 Lifetime Membership to the World of Inspiration eLibrary, click the following button:

Payment is made through our secure transaction agent, PayPal.
The transaction is in the language and currency of your choice.
"I want to just say 'WOW!' This collection is probably the best money I ever spent! I've already received many times over in personal enrichment after just 9 days. I've had a past metaphysical background, but even newcomers to this material will really benefit. Thanks again." ~ J.S. (Pennsylvania, USA)
"The collection is everything which you promised. And more! A superb contribution to the good of the world. Many thanks indeed." ~ R.P. (Georgia, USA)
"Just a short note of thanks for the library. I've only had membership for several days now but I already feel this is perhaps the most interesting compilation I have yet seen. Worth far more than the price of admission. The browser linked structure works well and makes it easy to manage such a large storehouse of information. It is rarely that I find something I like as much as this or that I feel strongly enough to write a note like this." ~ P.W. (Minnesota, USA)
Copyright © 1997-2016 Trans4mind Ltd