Insurance Companies and Independent Review Organizations:

Insurance Companies and Independent Review Organizations:

In my experience, the IROs are not so independent.

I recently wrote about being denied full coverage for contraception that my insurance company had originally told my doctor would not be subject to the deductible. I appealed the decision and was denied by my insurance company.

Which sucks, since the insurance company originally told my doctor that I wouldn’t be subject to the deductible. I was told that I would have to pay $200 and instead, I  have to pay $800 instead.

So, I appealed again to an Independent Review Organization and was denied. Because of ambiguous language in my Statement of Benefits.

The Independent Review Organization was not so independent and was in fact based in Salt Lake City. Apparently, the insurance company has full discretion to send the appeal to any nationally-approved Independent Review Organization that they want.

Doesn’t sound so independent to me since the insurance company has the right to choose where to send the appeal. I’m curious how many appeals relating to women’s issues get sent to Utah or other states with long histories of denying women equal rights.

The appeals process didn’t stop there for me. I’m not one to give up easily, even when I know the odds are stacked against me. I contacted the Insurance Commissioner; so far, there hasn’t been much action on my case, but they did verify that the insurance company had the right to send the appeal to whichever Independent Review Organization that they wanted to.

Which leads me to my next point.

What is the purpose of an Independent Review Organization if the insurance company is in direct contact with the organization? How independent can the review actually be if the Independent Review Organization is dependent on the health insurance company for business? How many Mormon doctors are in favor of birth control anyway?

If you get pre-approval for something from your insurance company, how can you ensure the insurance company is being honest? It might surprise some people, but insurance companies aren’t known for their honesty necessarily.

And, if the unfortunate truth that I learned today holds true, Independent Review Organizations might not be known for their honesty either.

The Independent Review Organizations seem to exist just for the purpose of rubber stamping the decisions of the insurance companies. I wish that I could believe that the world was a better place and that there was a legitimate and workable legal recourse against the insurance companies, but I don’t feel as if there is.