What is an independent review organization?

An independent review organization (IRO) is a type of external organization that reviews appeals of medical coverage decisions by health insurers in New Hampshire. IROs are set up by the state of New Hampshire to provide an impartial, unbiased review of health insurance claims. IROs ensure that individuals have their medical claims reviewed and resolved in a timely and accurate manner. The reviews conducted by IROs are also designed to protect the financial interests of both the patient and the health insurer. An IRO reviews an individual’s medical claims appeal to determine if the health insurer has rendered appropriate coverage and whether the medical care is medically necessary. In the event that an IRO decides the coverage was not appropriate, the individual may be reimbursed for the medical costs associated with the care. The IRO also considers the individual’s medical records and other information to make a decision about the coverage. The decision of an IRO is legally binding and is the final decision in the appeals process. In New Hampshire, the IRO is required to provide a written explanation of the decision, a copy of the medical records reviewed, and the appeals process. If the individual or insurance company disagrees with the decision of the IRO, they may file for an appeal with the state regulators.

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