Independent Review Organizations make Quality Healthcare Possible

Healthcare is personal, and whether or not one receives quality healthcare can greatly impact their life. There are several different factors that make up quality healthcare and one of the important factors is the option for independent reviews. Having an Independent Review Organization (IRO), such as Advanced Medical Reviews, perform a medical review on your requested service gives you extra comfort, extra support. Whether the IRO denies or approves the coverage, you are still assured that an extra pair of eyes has looked at your file, possibly consulted your doctor and reviewed your insurance coverage, to help decide what the best course of treatment is for your situation.

Thanks to the Affordable Care Act, patients now have the ability to personally request that a review be done on his or her situation. Having an IRO review your health coverage, is like having an editor read your paper/work before you submit it to your professor or boss. You want to make sure it’s the best that it can be, and that is what AMR does for your health. We take the requested review, assign it to the best suited reviewer, based on the service and requirements of the insurance company, and then let them decipher whether what has been prescribed is really the best action plan or if it falls within the guidelines of your insurance.

Quality healthcare can be defined in a lot of ways. It’s not necessarily just making you better as quickly as possible. It’s making sure your doctor picks the best route for your treatment, while staying within the guidelines of your insurance. It’s making sure you don’t get treatment that you don’t need or get denied treatment that you do need. There are a lot of twists and turns in healthcare coverage, and IRO’s exist to help both the insurance companies and the patient’s navigate those twists and turns as smoothly as possible. AMR works with insurance companies, state departments, the federal government as well as providers and patients, in order to perform top of the line reviews to help deliver quality healthcare to as many as possible.

If IROs did not exist, then you could never question a denial, or your insurance company would never question a course of treatment that they thought might not be the best one for your circumstance. There would be a lot less quality healthcare in the world, because there wouldn’t be the option to make sure it was personalized for you. For when a review is done on your file, the reviewer looks at the diagnosis, at the insurance plan, if requested, but also they look at the patient, they look at whatever is provided to find out if the patient’s history and current medical condition fits what is being prescribed. IRO’s provide you with the opportunity to speak up and show that you care about your healthcare and therefore we should too. And at AMR we do, we believe every patient should receive quality healthcare, and we strive to make that happen every day.

By Mickala J. Jauregui

Mickala is an AMR Office Supervisor who oversees all administrative duties and keeps the office running smoothly. Mickala is passionate about her family- she has a loving husband and an amazing 15 month old son. Fun fact: She studied Musical Theatre and spent a few years in New York City auditioning for Broadway.