What is an IRO?
An IRO, or independent review organization, provides independent medical reviews that help health insurance payers make consistent, evidence-based healthcare decisions regarding benefits coverage. An IRO is a healthcare advocate for both the patient and the payer by ensuring coverage for medically necessary treatments, while eliminating overutilization. As an intermediary, an IRO provides a ready-made source of timely, expert medical determinations that weigh both the medical and insurance side of healthcare information by providing access to objective expert medical expertise not readily available to payers. For the payer, an IRO monitors the group plan to assure that enrollees aren’t spending money on care that is not needed, is not medically necessary or doesn’t fit the accepted standard of care. For every enrollee in a healthcare group plan, an IRO ensures that each one receives the level of care required by the plan, while trying to manage cost of the plan to patients.
