A. An external review decision is binding on the health carrier. Failure to comply with the assigned independent review organization's external review decision shall be a knowing and willful violation of this section and subject to one or more of the following: (i) punishment as provided in § 38.2-218, (ii) the suspension or revocation of any license issued by the Commission, or (iii) any order that may be issued by the Commission pursuant to § 38.2-219.
B. An external review decision is binding on the covered person except to the extent the covered person has other remedies available under applicable federal or state law.
C. A covered person or his authorized representative may not file a subsequent request for external review involving the same adverse determination or final adverse determination for which the covered person has already received an external review decision.
2011, c. 788.
Structure Code of Virginia
Chapter 35.1 - Health Carrier Internal Appeal Process and External Review
§ 38.2-3558. Health carrier's internal appeal process
§ 38.2-3559. Notice of right to external review
§ 38.2-3560. Exhaustion of internal appeal process
§ 38.2-3561. Standard external review
§ 38.2-3562. Expedited external review
§ 38.2-3563. External review of experimental or investigational treatment adverse determinations
§ 38.2-3564. Binding nature of external review decision
§ 38.2-3565. Minimum qualifications for independent review organizations
§ 38.2-3566. Approval of independent review organizations
§ 38.2-3567. Independent review organizations to be held harmless
§ 38.2-3568. External review reporting requirements
§ 38.2-3569. Funding of external review