How to appeal a health insurance denial in Virginia
The exact steps for Virginia consumers: what the Virginia State Corporation Commission — Bureau of Insurance does, how external review works in your state, and the federal deadlines that apply on top.
Virginia regulator
- Department
- Virginia State Corporation Commission — Bureau of Insurance
External review
- Program
- State-administered
- Deadline
- 4 months after final internal denial
- Official page
- Open →
Step-by-step in Virginia
- Read the denial notice. The reason code drives your evidence and the appeal deadline is on the letter.
- File the internal appeal with your insurer within the plan's window (typically 180 days for ERISA/ACA plans; expedited turnaround 72 hours for urgent cases).
- Attach medical necessity evidence that maps to the exact denial reason: guideline citations, chart notes, prior-therapy documentation, peer-reviewed literature.
- Optional: file a complaint with Virginia State Corporation Commission — Bureau of Insurance at scc.virginia.gov/pages/Bureau-of-Insurance. A DOI complaint runs in parallel — it does not replace the internal appeal.
- Request external review within 4 months of the final internal denial. In Virginia, external review is administered by Virginia State Corporation Commission — Bureau of Insurance. The IRO decision is binding on the insurer.
Virginia program notes
Virginia administers external review under Va. Code § 38.2-3559 et seq.
How long do I have to appeal in Virginia?+
Typically 180 days from the denial notice for ERISA/ACA plans to file an internal appeal, and 4 months from the final internal denial to request external review (45 CFR § 147.136(d)(2)(ii)).
Can I file a complaint against my insurer with the Virginia State Corporation Commission — Bureau of Insurance?+
Yes, at https://scc.virginia.gov/pages/Bureau-of-Insurance. Consumer complaints can prompt market-conduct review, but binding relief on a specific claim comes from internal appeal plus external review.
Who decides external review in Virginia?+
An Independent Review Organization certified by Virginia State Corporation Commission — Bureau of Insurance, with a physician reviewer in the relevant specialty.
What if my case is urgent?+
Request an expedited appeal. Insurers must decide within 72 hours if delay would jeopardize life, health, or ability to regain maximum function.
What federal law protects appeal rights?+
29 CFR § 2560.503-1 (ERISA claim procedure) for employer plans; 45 CFR § 147.136 (ACA internal appeal + external review) for all non-grandfathered commercial plans.
Upload the denial letter. We'll build the internal appeal packet and, if needed, the Virginia external review submission.