Virginia insurance appeal rights
The Virginia State Corporation Commission's Bureau of Insurance regulates state-licensed commercial appeals and administers external review.
Internal appeal rights
Internal appeal: 180 days. Response 30 days standard, 72 hours urgent.
External review
Virginia external review through state-certified IROs is available after final internal denial; the IRO decision binds the carrier.
VA regulator
Virginia Bureau of Insurance. official site
Notable
- Bureau Consumer Services: 877-310-6560.
- Virginia operates a balance-billing protection program that complements the federal No Surprises Act.
How to file an external review in Virginia
Virginia runs its own external review program through the State Corporation Commission's Bureau of Insurance, rather than deferring to the federal HHS process. After you exhaust your insurer's internal appeals, you submit a completed External Review Request Form (Form 216-A) to the Bureau, which must receive it within 120 days of the notice telling you of your external review right. The Bureau assigns an Independent Review Organization, and that IRO's decision is binding on the plan. Standard review typically takes up to 45 days. If your treating provider certifies that waiting would seriously jeopardize your life, health, or ability to regain function, an expedited review is available, decided within 72 hours. The service is free to you.
Virginia appeal questions
How do I request an external review in Virginia?
File a completed External Review Request Form (Form 216-A) with the Virginia State Corporation Commission's Bureau of Insurance after you have finished your insurer's internal appeal process. The Bureau then assigns an Independent Review Organization to evaluate your denial. You can also contact the Bureau of Insurance for guidance before submitting and to confirm which supporting documents and additional forms your situation requires.
What is the deadline to file external review in Virginia?
The Bureau of Insurance must receive your complete request within 120 days after the date you receive notice of your right to an external review, which generally comes with your final internal denial. Missing this 120-day window can forfeit your right to review, so it is wise to submit early. If your health is urgent, you do not have to wait for the internal appeal to fully conclude before requesting an expedited review.
Does an external review in Virginia cost anything?
No. Virginia's external review through the Bureau of Insurance is a free service for consumers. You are not charged for the Independent Review Organization's evaluation, and the cost of the IRO is borne by the system rather than the patient. This makes it the last no-cost option to contest a denial outside of court.
Does Virginia external review apply to self-funded or ERISA plans?
Often not. Virginia's program covers fully insured plans issued in the state, but most self-funded employer plans fall under federal ERISA and instead use the federal HHS-administered external review process. A self-insured plan is only eligible for Virginia's process if it has opted in. Check your plan documents or ask your HR department whether your coverage is self-funded, since that determines which path applies.
Filed a denial in Virginia?
We work under VA rules and structure the appeal under the strongest available state and federal protections.
Start Your AppealState law information is provided for general guidance and is not legal advice. Confirm with your state regulator or a licensed attorney for your specific case.