{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3564.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3564.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3564.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3564.html"}],"law_id":78633,"edition_id":1,"section_id":78633,"structure_id":14588,"section_number":"38.2-3564","catch_line":"Binding nature of external review decision","history":"2011, c. 788.","full_text":"A\n\nAn 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\n\nAn 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\n\nA 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.","order_by":null,"text":{"0":{"id":281757,"text":"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.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":281758,"text":"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.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":281759,"text":"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.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B"}},"ancestry":[{"id":14588,"edition_id":1,"name":"Health Carrier Internal Appeal Process and External Review","identifier":"35.1","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:48:47","date_modified":"2026-06-26 03:48:47","permalink":{"id":215937,"object_type":"structure","relational_id":14588,"identifier":"35.1","token":"38.2\/35.1","url":"\/38.2\/35.1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":58140,"structure_id":14588,"section_number":"38.2-3556","catch_line":"Definitions","url":"\/38.2-3556\/","token":"38.2\/35.1\/38.2-3556","metadata":false},{"id":56086,"structure_id":14588,"section_number":"38.2-3557","catch_line":"Scope of chapter","url":"\/38.2-3557\/","token":"38.2\/35.1\/38.2-3557","metadata":false},{"id":56843,"structure_id":14588,"section_number":"38.2-3558","catch_line":"Health carrier's internal appeal process","url":"\/38.2-3558\/","token":"38.2\/35.1\/38.2-3558","metadata":false},{"id":77920,"structure_id":14588,"section_number":"38.2-3559","catch_line":"Notice of right to external review","url":"\/38.2-3559\/","token":"38.2\/35.1\/38.2-3559","metadata":false},{"id":65207,"structure_id":14588,"section_number":"38.2-3560","catch_line":"Exhaustion of internal appeal process","url":"\/38.2-3560\/","token":"38.2\/35.1\/38.2-3560","metadata":false},{"id":66856,"structure_id":14588,"section_number":"38.2-3561","catch_line":"Standard external review","url":"\/38.2-3561\/","token":"38.2\/35.1\/38.2-3561","metadata":false},{"id":83961,"structure_id":14588,"section_number":"38.2-3562","catch_line":"Expedited external review","url":"\/38.2-3562\/","token":"38.2\/35.1\/38.2-3562","metadata":false},{"id":63745,"structure_id":14588,"section_number":"38.2-3563","catch_line":"External review of experimental or investigational treatment adverse determinations","url":"\/38.2-3563\/","token":"38.2\/35.1\/38.2-3563","metadata":false},{"id":78633,"structure_id":14588,"section_number":"38.2-3564","catch_line":"Binding nature of external review decision","url":"\/38.2-3564\/","token":"38.2\/35.1\/38.2-3564","metadata":false},{"id":63044,"structure_id":14588,"section_number":"38.2-3565","catch_line":"Minimum qualifications for independent review organizations","url":"\/38.2-3565\/","token":"38.2\/35.1\/38.2-3565","metadata":false},{"id":59040,"structure_id":14588,"section_number":"38.2-3566","catch_line":"Approval of independent review organizations","url":"\/38.2-3566\/","token":"38.2\/35.1\/38.2-3566","metadata":false},{"id":79665,"structure_id":14588,"section_number":"38.2-3567","catch_line":"Independent review organizations to be held harmless","url":"\/38.2-3567\/","token":"38.2\/35.1\/38.2-3567","metadata":false},{"id":81396,"structure_id":14588,"section_number":"38.2-3568","catch_line":"External review reporting requirements","url":"\/38.2-3568\/","token":"38.2\/35.1\/38.2-3568","metadata":false},{"id":75481,"structure_id":14588,"section_number":"38.2-3569","catch_line":"Funding of external review","url":"\/38.2-3569\/","token":"38.2\/35.1\/38.2-3569","metadata":false},{"id":83489,"structure_id":14588,"section_number":"38.2-3570","catch_line":"Disclosure requirements","url":"\/38.2-3570\/","token":"38.2\/35.1\/38.2-3570","metadata":false},{"id":56157,"structure_id":14588,"section_number":"38.2-3571","catch_line":"Regulations","url":"\/38.2-3571\/","token":"38.2\/35.1\/38.2-3571","metadata":false}],"previous_section":{"id":63745,"structure_id":14588,"section_number":"38.2-3563","catch_line":"External review of experimental or investigational treatment adverse determinations","url":"\/38.2-3563\/","token":"38.2\/35.1\/38.2-3563","metadata":false},"next_section":{"id":63044,"structure_id":14588,"section_number":"38.2-3565","catch_line":"Minimum qualifications for independent review organizations","url":"\/38.2-3565\/","token":"38.2\/35.1\/38.2-3565","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3564\/","history_text":"

This law was first created in 2011. The record of its establishment is cataloged in chapter 788<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year.<\/p>","references":false,"refers_to":[{"id":64490,"section_number":"38.2-218","catch_line":"Penalties and restitution payments","order_by":null,"url":"\/38.2-218\/"}],"permalink":{"id":215971,"object_type":"law","relational_id":78633,"identifier":"38.2-3564","token":"38.2\/35.1\/38.2-3564","url":"\/38.2-3564\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3564\/","token":"38.2\/35.1\/38.2-3564","dublin_core":{"Title":"Binding nature of external review decision","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3564","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> An external review decision is binding on the health carrier<\/span>. Failure to comply with the assigned independent review organization<\/span>’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<\/a>, (ii) the suspension or revocation<\/span> of any license issued by the Commission<\/span>, or (iii) any order<\/span> that may be issued by the Commission<\/span> pursuant to § 38.2-219<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> An external review decision is binding on the covered person<\/span> except to the extent the covered person<\/span> has other remedies available under applicable federal or state<\/span> law<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> A covered person<\/span> or his authorized representative<\/span> may not file a subsequent request for external review involving the same adverse determination or final adverse determination<\/span> for which the covered person<\/span> has already received an external review decision. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nBINDING NATURE OF EXTERNAL REVIEW DECISION (\u00a7 38.2-3564)\n\nA. An external review decision is binding on the health carrier. Failure to\ncomply with the assigned independent review organization’s external review\ndecision shall be a knowing and willful violation of this section and subject to\none or more of the following: (i) punishment as provided in § 38.2-218,\n(ii) the suspension or revocation of any license issued by the Commission, or\n(iii) any order that may be issued by the Commission pursuant to §\n38.2-219.\n\nB. An external review decision is binding on the covered person except to the\nextent the covered person has other remedies available under applicable federal\nor state law.\n\nC. A covered person or his authorized representative may not file a subsequent\nrequest for external review involving the same adverse determination or final\nadverse determination for which the covered person has already received an\nexternal review decision.\n\nHISTORY: 2011, c. 788.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}