Independent Review Organization/Medical Reviews
MET is an Independent Review Organization (IRO) accredited through URAC, a non-profit organization that helps promote health care quality through standards that validate organizations are committed to a fair and impartial medical review process that benefit both patient and physician appeals.
URAC accredited IROs undergo a thorough screening process to ensure health plans and consumers receive a comprehensive review and objective appeal decision.
We provide nationwide Independent Medical Review services for state insurance departments, group health plans, worker’s compensation, utilization review companies, hospitals, employers, benefit administrators, attorneys, and casualty insurers.
Our peer reviews are free from conflict and performed by highly-trained, unbiased legal professionals, board-certified physicians, and qualified healthcare providers, in compliance with specific state, federal, and URAC mandates.
Utilizing an evidence-based decision process, our peer reviews reduce both administrative costs and liability while improving member satisfaction.
First Level Review
We review whether an initial request for a medical service or treatment is medically necessary or experimental/investigational. As a URAC-accredited IRO, we maintain higher industry standards for validating your review through our team of medical professionals resulting in significant cost savings and enhanced member satisfaction.
Internal Medical Appeal (Second Level Review)
When a first level review is denied, one may wonder if the denial was rushed or biased. Outsourcing your second level review to MET's URAC-accredited IRO team of physicians, who are active in the specialties being discussed, will provide you with an unbiased second level review, enhancing member satisfaction.
When one has exhausted the internal review process, an external review can be requested to determine whether the denied medical treatment is medically necessary or experimental/investigational. MET's URAC-accredited IRO team can provide an unbiased external review, using physicians who currently practice in the specialties under review, for institutions that fall outside the State's IRO coverage, helping to enhance member satisfaction.
Contractual (health plan) Appeal
Our team of lawyers conducts reviews regarding the rescission of benefits, benefit interpretations, reimbursement issues, and other administrative/legal concerns to determine if a plan was applied appropriately. Consult with our legal team to determine next steps in your health plan appeal.
Our team of medical experts, through a comprehensive evaluation of the medical evidence supported by objective findings, defines the appropriate limits of the claimed injury, thereby reducing the amount spent on non-compensable medical treatment. To begin the process of saving money, call us today!
Medical Director Consultation
Our medical director consultants provide reviews of current policies, verify the credibility of your peer review program, design medical protocols, assist with program development, and perform health audits. To learn more about our medical director consultants, call us today.