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68 chapters · 1,805 sections in this title.
Va. Code Ann. § 38.2-3556 Definitions
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As used in this chapter, unless the context requires a different meaning: "Adverse determination" means a determination by a health carrier or its designee utilization review entity that an admission, availability of care, continued stay, or other health care service that is a co…
Va. Code Ann. § 38.2-3557 Scope of chapter
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A. This chapter shall apply to all health carriers, except that the provisions of this chapter shall not apply to a policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage, credit, disability income, hospital indemni…
Va. Code Ann. § 38.2-3558 Health carrier's internal appeal process
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Each health carrier shall establish an internal appeal process, including a process for urgent care appeals, to consider a utilization review adverse determination or other adverse benefit determination or decision that is appealed by a covered person, his authorized representati…
Va. Code Ann. § 38.2-3559 Notice of right to external review
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A. A health carrier shall notify the covered person in writing of an adverse determination or final adverse determination and the covered person's right to request an external review within five business days after the adverse determination or final adverse determination has been…