West Virginia: Start Here
Beginner guide for West Virginia—HealthCare.gov, OIC external review, § 33-24-7s PA & appeals.
Read guideState playbook
West Virginia
State insurers, legislation, and appeal resources for patients and advocates in West Virginia.
4 guides
West Virginia Prior Authorization Law
§ 33-24-7s—5-day PA, gold carding, ePA portal; SB 267 / SB 833 reforms.
Read guideWest Virginia Health Insurance Appeals and Grievances
CSR 114-96 grievance, 180-day filing, 30-day deemed exhaustion, path to IRO.
Read guideWest Virginia External Review (OIC / IRO)
Binding on issuer—4 months 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.
- Highmark Blue Cross Blue Shield West Virginia
- CareSource
- Molina Healthcare of West Virginia
- HealthCare.gov (West Virginia)
- Mountain Health Promise / Medicaid MCOs
External appeals
After internal appeal, for eligible West Virginia fully insured plans only.
- OIC — external review
- Medicaid — BMS fair hearing