Virginia: Start Here
Beginner guide for Virginia—HealthCare.gov, SCC external review, drug PA & appeals.
Read guideState playbook
Virginia
State insurers, legislation, and appeal resources for patients and advocates in Virginia.
4 guides
Virginia Prior Authorization Law
§ 38.2-3407.15:2—24-hour urgent drug PA, 2-day standard; ePA; step therapy.
Read guideVirginia Health Insurance Appeals and Grievances
14VAC5-216 internal appeal, 180-day filing, 30-day deemed exhaustion.
Read guideVirginia External Review (SCC / IRO)
Free binding review—120 days to file, 45-day standard / 72-hour expedited.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Anthem (HealthKeepers)
- Kaiser Permanente Mid-Atlantic
- Optima Health (Sentara)
- Molina Healthcare
- Oscar Health
- HealthCare.gov (Virginia)
- Cardinal Care (Medicaid MCOs)
External appeals
After internal appeal, for eligible Virginia fully insured plans only.
- SCC Bureau — external review
- Medicaid — DMAS fair hearing