For Consumers

What is an independent review organization (IRO)?

What is an IRO?

If your health insurer upholds a claim denial after you completed their appeals process, an independent review organization (IRO) provides you with another appeal option. The IRO process involves an external review of your appeal by an organization that isn’t affiliated with your health insurer and doesn’t have a financial interest in the outcome of your case. All IROs are certified and regulated by the Washington State Department of Health (www.doh.wa.gov).

What is an independent review decision?

The IRO can either uphold or overturn the insurance company’s position, but once an IRO reviews an appeal, its decision is binding.

How does the IRO decision search tool work?

Our IRO search tool allows you to search 2016 through 2018 IRO decisions for the insurance companies we regulate. You can review detailed case information of these decisions, and modify your search based on a number of factors, including cases involving a particular health insurer, diagnosis or treatment.

How can I find out more about IROs?/How can I appeal a health insurance denial?

For tips and guidance on how to appeal a health insurance denial, including how to request an IRO, visit our web section on appealing a health insurance denial.