External review in Virginia: deadline, cost and how to ask
Virginia runs its own independent review of denials: External Review. You generally have 120 days to ask for it.
External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.
Checked against official sources: October 30, 2026.
Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.
Step 2: Outside review in Virginia
- Program
External Review
- Who runs it
- Virginia State Corporation Commission, Bureau of Insurance (assigns an independent review organization): Fully insured plans issued in Virginia, and self-insured employer plans that opted in to Virginia's process
- Deadline to ask
120 days
A complete request must reach the Bureau of Insurance within 120 days after the date you received notice of your right to external review. The reviewer decides a standard review within 45 days.
- The deadline runs from
The date you receive the notice of your right to external review (usually in the insurer's final denial)
- Do I have to appeal to my plan first?
Usually you must finish the insurer's internal appeal first. You do not have to if the denial relates to treatment of cancer, if the insurer agrees to waive it, or if you filed an appeal and got no written decision within 30 days (unless you agreed to a delay). If you file an expedited internal appeal, you can file an expedited external review at the same time.
- When you can go without a plan answer
30 days after you file your internal appeal
- Cost
External review is free. The insurer pays the independent review organization.
- What can be reviewed
Denials of covered services as not medically necessary, or as experimental or investigational (also appropriateness, health care setting, level of care or effectiveness). Not eligible: out-of-network denials unless based on medical necessity (some out-of-network payment disputes may go to the federal No Surprises Act process), Medicare, Medicaid, TRICARE, dental, vision and other limited benefits, and self-insured plans that did not opt in.
- Is the decision final?
The decision is binding on the insurer, and on you except where you have other remedies under state or federal law. You cannot ask for a second external review of the same denial.
- How to ask
Contact the Bureau of Insurance first (externalreview@scc.virginia.gov) to discuss your case and which forms you need. File the External Review Request Form with the Bureau, plus Form 216-B if someone acts for you, Form 216-C (physician certification) for expedited review, or Form 216-D for experimental or investigational denials. Mailing address: Bureau of Insurance, P.O. Box 1157, Richmond, VA 23218. After the reviewer is assigned, you have 5 business days to send extra information.
Law: Va. Code 38.2-3557, 38.2-3560, 38.2-3561, 38.2-3562, 38.2-3563, 38.2-3564, 38.2-3569; Va. Code 14VAC5-216
Source: Form 216-A
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for Virginia are listed on the Virginia page.