In the context of insurance, what describes a self-funded policy requiring third-party oversight?

A self-funded policy requiring third-party oversight is best described by the concept of Case Management Treatment Notification. In this scenario, organizations that opt for self-funding are taking on the financial risk of providing health care benefits to their employees directly rather than purchasing a fully insured policy. However, these self-funded programs often engage third-party administrators (TPAs) to manage claims processing and health management services.

The reason Case Management Treatment Notification fits this description is that it emphasizes the role of overseeing patient care and ensuring that treatment is medically necessary and efficiently managed, which aligns with the need for external oversight in self-funded arrangements. Such oversight can involve assessing treatment plans and ensuring appropriate use of resources, which is essential for maintaining fiscal responsibility in self-funded structures.

In contrast, a commercial policy typically involves traditional insurance models where the insurer takes on the risk, and the insured does not generally require third-party oversight since the insurer manages all aspects of care. The Health Insurance Marketplace refers to a structured venue for purchasing health insurance and is not specific to self-funding. An authorization procedure pertains to obtaining pre-approval for services but does not inherently denote a self-funded situation requiring oversight.