# Virginia HB484: Health insurance; ethics and fairness in carrier business practices, downcoded claims.

Virginia HB484, Health insurance; ethics and fairness in carrier business practices, downcoded claims., is a 2026 Regular Session House bill sponsored by Irene Shin (Democratic); status signed, last action 2026-04-22 (Senate concurred in Governor's recommendation (39-Y 0-N 0-A)); PRIA reads it as touching household money (as of 2026-10-12).

- Canonical: https://policyrisk.com/state-bill/VA-HB484-2026
- As of: 2026-10-12
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: Virginia HB484
- State: Virginia
- Session: 2026 Regular Session
- Title: Health insurance; ethics and fairness in carrier business practices, downcoded claims.
- Status: signed
- Chamber: House
- Introduced: 2026-01-12
- Last action: 2026-04-22, Senate concurred in Governor's recommendation (39-Y 0-N 0-A)
- Sponsor: Irene Shin (Democratic)
- Cosponsors: 0
- Touches household money: yes
- Roll calls: 11 (457 yes, 3 no in all)
- Economic provisions PRIA read: 14

## Summary

Health insurance; ethics and fairness in carrier business practices; downcoded claims. Prohibits a carrier, intermediary, administrator, or representative of a carrier from downcoding a claim unless the decision to downcode is determined by a person or electronic system that reflects correct coding standards and considers all relevant patient data from the billing provider in making the determination. The bill requires a carrier, intermediary, administrator, or representative that downcodes a claim to provide certain notice to the provider. The bill requires that all downcoding dispute decisions are reviewed and adjudicated by a natural person.

## Bill overview: provisions PRIA read

- Accident lawsuits cannot alone block care: benefit, low. Carrier-provider contracts must bar discrimination solely because an enrollee is suing, or may sue, over a motor vehicle accident. This does not require treatment when the enrollee threatened or brought a professional-liability claim or regulatory complaint against the provider or specified related…
- Patients get deadlines for care approvals: benefit, low. Beginning January 1, 2027, carriers must respond to expedited care-approval requests within 72 hours, including weekends. Standard requests have a seven-calendar-day deadline. Responses must approve, deny, or identify missing information; completed additions trigger the same deadline for a final de…
- Patients get publicly posted approval rules: benefit, low. Beginning January 1, 2027, carriers must publicly post care-approval services, codes, procedures, forms, and effective dates in one electronic location. Providers must get at least 30 calendar days’ notice of changes, and postings must be updated when changes start. Advance notice is not required w…
- Fair insurance rules cover more carriers: benefit, low. Virginia’s fair-business rules cover more licensed entities that offer managed-care plans or arrange health services regulated as insurance. Carriers and providers remain responsible for covered duties when vendors or subcontractors do the work.
- Insurers face limits on reclaiming payments: benefit, low. Carriers must identify and explain a paid claim in writing before denying it afterward or seeking repayment. Recovery requires fraud, duplicate payment, services not delivered, or payment made no more than 12 months earlier. A written agreement can allow withholding or offset after 12 months, with…
- Providers can avoid claim payment fees: benefit, low. Carriers must disclose payment methods that charge providers transaction, processing, or similar fees in provider contracts. This includes methods used by payment agents. Carriers must offer a fee-free option. They must use it when the provider chooses it and supplies the required enrollment inform…
- Providers can challenge claim coding reductions: benefit, low. Carriers may lower a claim’s service code only through a person or system using correct coding standards and relevant patient data. They must notify providers and identify the adjustment and payment-explanation codes. Providers get at least 180 days to dispute coding reductions, human review of eve…
- Providers get clearer claim payment deadlines: benefit, low. Carriers must pay provider-contract claims within 40 days of receipt when payment is reasonably clear. Supported disputes about claims, eligibility, another payer, or fraud can delay payment. Carriers must keep receipt-date records that claim submitters can inspect. A clean claim includes provider…
- Providers get clearer insurance contract terms: benefit, low. Carriers must provide applicable fee schedules, payment methods, and material contract documents before providers sign. They must offer ways to check coverage, medical need, authorization, reimbursement, coding, and claim-processing rules. Contracts must disclose routine claim combining or coding r…
- Providers get payment protections for approved care: benefit, low. Carriers must pay for services they approved or confirmed in advance as medically needed and covered. Exceptions include unsupported claims, another responsible payer, prior payment, fraud, major wrong information, and certain ineligible enrollees. Fraud found after care can also justify denial. Wh…
- Some health plans lack approval protections: cost, low. The law’s prior-approval section does not cover certain health maintenance organizations. The plan must contract with a multispecialty physician group whose doctors are both employees and shareholders. The group may also contract with community providers. The plan must provide and arrange physician…
- Online care approvals require provider upgrades: mixed, low. Carriers must maintain an electronic connection for providers’ approval requests for medical items and services, following federal standards. The deadline is January 1, 2027, unless the Centers for Medicare and Medicaid Services sets a later date. Federal enforcement delays or suspensions can also…
- Providers gain remedies, face complaint steps: mixed, low. Providers harmed by carrier violations or breaches of required contract terms may sue for actual losses. A finding of gross negligence and willful conduct allows up to three times actual losses; legal fees and court costs may also be awarded. Each affected claim counts separately, and carriers, net…
- Providers get coverage checks, electronic paperwork: mixed, low. Beginning July 1, 2025, carriers under Virginia State Corporation Commission oversight must offer providers electronic coverage checks. Carriers must also send provider contracts, amendments, and notices electronically by July 1, 2025. Providers must submit those materials electronically by January…

## Sponsors and cosponsors

- Sponsor: Irene Shin (Democratic), House

## Roll call votes

| Date | Chamber | Motion | Result | Yes | No | Other |
| --- | --- | --- | --- | --- | --- | --- |
| 2026-04-22 | House | House concurred in Governor's recommendation | pass | 99 | 1 |   |
| 2026-04-22 | Senate | Senate concurred in Governor's recommendation | pass | 39 | 0 |   |
| 2026-03-02 | House | Senate substitute agreed to by House | pass | 98 | 0 |   |
| 2026-02-26 | Senate | Commerce and Labor Substitute agreed to | pass | 0 | 0 |   |
| 2026-02-26 | Senate | Passed Senate with substitute Block Vote | pass | 40 | 0 |   |
| 2026-02-25 | Senate | Constitutional reading dispensed Block Vote (on 2nd reading) | pass | 40 | 0 |   |
| 2026-02-25 | Senate | Passed by for the day Block Vote (Voice Vote) | pass | 0 | 0 |   |
| 2026-02-23 | Senate | Reported from Commerce and Labor with substitute | pass | 14 | 0 |   |
| 2026-02-11 | House | Read third time and passed House | pass | 97 | 1 |   |
| 2026-02-05 | House | Reported from Labor and Commerce with substitute | pass | 21 | 1 |   |
| 2026-02-03 | House | Subcommittee recommends reporting with substitute | pass | 9 | 0 |   |

## Actions (41)

- 2026-04-22: Senate concurred in Governor's recommendation (39-Y 0-N 0-A) (Senate)
- 2026-04-22: House concurred in Governor's recommendation (99-Y 1-N 0-A) (House)
- 2026-04-22: Acts of Assembly Chapter text (CHAP1055) (Governor)
- 2026-04-22: Approved by Governor-Chapter 1055 (effective 7/1/2026) (Governor)
- 2026-04-22: Signed by President (Senate)
- 2026-04-22: Signed by Speaker (House)
- 2026-04-22: Governor's recommendation adopted (Governor)
- 2026-04-13: Governor's recommendation received by House (Governor)
- 2026-03-12: Fiscal Impact Statement from State Corporation Commission (HB484) (House)
- 2026-03-10: Governor's Action Deadline 11:59 p.m., April 13, 2026 (Governor)
- 2026-03-10: Enrolled Bill communicated to Governor on March 10, 2026 (House)
- 2026-03-05: Bill text as passed House and Senate (HB484ER) (House)
- 2026-03-05: Enrolled (House)
- 2026-03-05: Signed by President (Senate)
- 2026-03-05: Signed by Speaker (House)
- 2026-03-03: Fiscal Impact Statement from State Corporation Commission (HB484) (House)
- 2026-03-02: Senate substitute agreed to by House (98-Y 0-N 0-A) (House)
- 2026-02-26: Passed Senate with substitute Block Vote (40-Y 0-N 0-A) (Senate)
- 2026-02-26: Commerce and Labor Substitute agreed to (Senate)
- 2026-02-26: Engrossed by Senate - committee substitute (Senate)
- 2026-02-26: Read third time (Senate)
- 2026-02-25: Passed by for the day Block Vote (Voice Vote) (Senate)
- 2026-02-25: Constitutional reading dispensed Block Vote (on 2nd reading) (40-Y 0-N 0-A) (Senate)
- 2026-02-25: Rules suspended (Senate)
- 2026-02-24: Committee substitute printed 26108293D-S1 (Senate)
- 2026-02-23: Senate committee offered (Senate)
- 2026-02-23: Reported from Commerce and Labor with substitute (14-Y 0-N) (Senate)
- 2026-02-12: Referred to Committee on Commerce and Labor (Senate)
- 2026-02-12: Constitutional reading dispensed (on 1st reading) (Senate)
- 2026-02-11: Read third time and passed House (97-Y 1-N 0-A) (House)
- 2026-02-10: Engrossed by House - committee substitute (House)
- 2026-02-10: committee substitute agreed to (House)
- 2026-02-10: Read second time (House)
- 2026-02-09: Read first time (House)
- 2026-02-05: Committee substitute printed 26106356D-H1 (House)
- 2026-02-05: Reported from Labor and Commerce with substitute (21-Y 1-N) (House)
- 2026-02-03: House subcommittee offered (House)
- 2026-02-03: Subcommittee recommends reporting with substitute (9-Y 0-N) (House)
- 2026-01-19: Assigned HCL sub: Subcommittee #1 (House)
- 2026-01-12: Referred to Committee on Labor and Commerce (House)
- 2026-01-12: Prefiled and ordered printed; Offered 01-14-2026 26102714D (House)

## Bill text

- Chaptered, 2026-04-22: [HTML](https://lis.blob.core.windows.net/files/1225217.HTML), [PDF](https://lis.blob.core.windows.net/files/1225216.PDF)
- Reenrolled, 2026-04-22: [HTML](https://lis.blob.core.windows.net/files/1219958.HTML), [PDF](https://lis.blob.core.windows.net/files/1219957.PDF)
- Gov Recommendation, 2026-04-13: [HTML](https://lis.blob.core.windows.net/files/1219461.HTML)
- Enrolled, 2026-03-05: [HTML](https://lis.blob.core.windows.net/files/1193999.HTML), [PDF](https://lis.blob.core.windows.net/files/1193998.PDF)
- Substitute, 2026-02-24: [HTML](https://lis.blob.core.windows.net/files/1177650.HTML), [PDF](https://lis.blob.core.windows.net/files/1177649.PDF)
- Substitute, 2026-02-23: [HTML](https://lis.blob.core.windows.net/files/1177098.HTML), [PDF](https://lis.blob.core.windows.net/files/1177097.PDF)
- Substitute, 2026-02-05: [HTML](https://lis.blob.core.windows.net/files/1129887.HTML), [PDF](https://lis.blob.core.windows.net/files/1129886.PDF)
- Substitute, 2026-02-04: [HTML](https://lis.blob.core.windows.net/files/1115871.HTML), [PDF](https://lis.blob.core.windows.net/files/1115870.PDF)
- Substitute, 2026-02-03: [HTML](https://lis.blob.core.windows.net/files/1115492.HTML), [PDF](https://lis.blob.core.windows.net/files/1115491.PDF)
- Introduced, 2026-01-12: [HTML](https://lis.blob.core.windows.net/files/1084624.HTML), [PDF](https://lis.blob.core.windows.net/files/1084623.PDF)

## Related bills

- HB5: Employment; paid sick leave, civil penalties. (signed)
- SB199: Employment; paid sick leave, civil penalties. (signed)
- HB95: Va. Residential Landlord and Tenant Act; landlord remedies, noncompliance with rental agreement. (signed)
- HB1393: Electric utilities; pilot program for energy assistance and weatherization for certain individuals. (signed)
- HB834: Virginia Residential Landlord and Tenant Act; fire or casualty damage, termination by landlord. (signed)
- HB675: Protection of employees; coercion or threat based on immigration status, civil penalty. (signed)

## Sources
- [Chaptered (HTML)](https://lis.blob.core.windows.net/files/1225217.HTML)
- [Chaptered (PDF)](https://lis.blob.core.windows.net/files/1225216.PDF)
- [Reenrolled (HTML)](https://lis.blob.core.windows.net/files/1219958.HTML)
- [Reenrolled (PDF)](https://lis.blob.core.windows.net/files/1219957.PDF)
- [Gov Recommendation (HTML)](https://lis.blob.core.windows.net/files/1219461.HTML)
- [Enrolled (HTML)](https://lis.blob.core.windows.net/files/1193999.HTML)
- [Enrolled (PDF)](https://lis.blob.core.windows.net/files/1193998.PDF)
- [Substitute (HTML)](https://lis.blob.core.windows.net/files/1177650.HTML)
- [Substitute (PDF)](https://lis.blob.core.windows.net/files/1177649.PDF)
- [Substitute (HTML)](https://lis.blob.core.windows.net/files/1177098.HTML)
- [Substitute (PDF)](https://lis.blob.core.windows.net/files/1177097.PDF)
- [Substitute (HTML)](https://lis.blob.core.windows.net/files/1129887.HTML)
- [Substitute (PDF)](https://lis.blob.core.windows.net/files/1129886.PDF)
- [Substitute (HTML)](https://lis.blob.core.windows.net/files/1115871.HTML)
- [Substitute (PDF)](https://lis.blob.core.windows.net/files/1115870.PDF)
- [Substitute (HTML)](https://lis.blob.core.windows.net/files/1115492.HTML)
- [Substitute (PDF)](https://lis.blob.core.windows.net/files/1115491.PDF)
- [Introduced (HTML)](https://lis.blob.core.windows.net/files/1084624.HTML)
- [Introduced (PDF)](https://lis.blob.core.windows.net/files/1084623.PDF)

## Related
- [HB5: Employment; paid sick leave, civil penalties.](https://policyrisk.com/state-bill/VA-HB5-2026)
- [SB199: Employment; paid sick leave, civil penalties.](https://policyrisk.com/state-bill/VA-SB199-2026)
- [HB95: Va. Residential Landlord and Tenant Act; landlord remedies, noncompliance with…](https://policyrisk.com/state-bill/VA-HB95-2026)
- [HB1393: Electric utilities; pilot program for energy assistance and weatherization for…](https://policyrisk.com/state-bill/VA-HB1393-2026)
- [HB834: Virginia Residential Landlord and Tenant Act; fire or casualty damage, terminat…](https://policyrisk.com/state-bill/VA-HB834-2026)
- [HB675: Protection of employees; coercion or threat based on immigration status, civil…](https://policyrisk.com/state-bill/VA-HB675-2026)
- [Virginia bills](https://policyrisk.com/states/virginia/bills)
- [Virginia state hub](https://policyrisk.com/states/virginia)
- [All state legislation](https://policyrisk.com/state-bills)

Source: PRIA, https://policyrisk.com/state-bill/VA-HB484-2026 (as of 2026-10-12).