<?xml version="1.0"?>
<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>60836</law_id><section_number>38.2-3445</section_number><catch_line>Patient access to emergency services</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>38.2-3445.06</reference><reference>38.2-3445.07</reference><reference>38.2-3445.2</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="38.2">Insurance</unit><unit label="chapter" level="2" order_by="1" identifier="34">Provisions Relating to Accident and Sickness Insurance</unit><unit label="article" level="3" order_by="1" identifier="6">Federal Market Reforms</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> Notwithstanding any provision of &#xA7;&#xA0;<a class="law" title="Access to obstetrician-gynecologists" href="/38.2-3407.11/">38.2-3407.11</a>, <a class="law" title="Patient access to emergency services" href="/38.2-4312.3/">38.2-4312.3</a>, or any other section of this title to the contrary, if a health carrier providing individual or group health <span class="dictionary">insurance</span> coverage provides any benefits with respect to services in an emergency department of a hospital, the health carrier shall provide coverage for emergency services: <a id="paragraph-222372" class="section-permalink" href="https://vacode.org/38.2-3445/#A"><i class="fa fa-link"/></a></p></section>
						<section id="A1" class="indent-1"><p><span class="prefix-number">1.</span> Without the need for any prior authorization determination, regardless of whether the emergency services are provided on an in-network or out-of-network basis; <a id="paragraph-222373" class="section-permalink" href="https://vacode.org/38.2-3445/#A1"><i class="fa fa-link"/></a></p></section>
						<section id="A2" class="indent-1"><p><span class="prefix-number">2.</span> Without regard to the final diagnosis rendered to the covered <span class="dictionary">person</span> or whether the health care provider furnishing the emergency services is a participating health care provider with respect to such services; <a id="paragraph-222374" class="section-permalink" href="https://vacode.org/38.2-3445/#A2"><i class="fa fa-link"/></a></p></section>
						<section id="A3" class="indent-1"><p><span class="prefix-number">3.</span> If such services are provided out-of-network, without imposing any administrative requirement or limitation on coverage that is more restrictive than the requirements or limitations that apply to such services received from an in-network provider; <a id="paragraph-222375" class="section-permalink" href="https://vacode.org/38.2-3445/#A3"><i class="fa fa-link"/></a></p></section>
						<section id="A4" class="indent-1"><p><span class="prefix-number">4.</span> If such services are provided out-of-network, the health carrier shall pay the out-of-network provider in accordance with &#xA7; <a class="law" title="Balance billing for certain services; prohibited" href="/38.2-3445.01/">38.2-3445.01</a> less any cost-sharing requirement. Any such cost-sharing requirement shall not exceed the cost-sharing requirement that would apply if such services were provided in-network as provided in &#xA7; <a class="law" title="Balance billing for certain services; prohibited" href="/38.2-3445.01/">38.2-3445.01</a>; and <a id="paragraph-222376" class="section-permalink" href="https://vacode.org/38.2-3445/#A4"><i class="fa fa-link"/></a></p></section>
						<section id="A5" class="indent-1"><p><span class="prefix-number">5.</span> Without regard to any term or condition of such coverage other than the exclusion of or coordination of benefits or an affiliation or waiting period. <a id="paragraph-222377" class="section-permalink" href="https://vacode.org/38.2-3445/#A5"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> Coverage for emergency services that are related to mental health services or substance abuse services, as those terms are defined in &#xA7; <a class="law" title="Coverage for mental health and substance use disorders" href="/38.2-3412.1/">38.2-3412.1</a>, shall be provided in accordance with the federal Mental Health Parity and Addiction <span class="dictionary">Equity</span> Act of 2008, P.L. 110-343, even where those requirements would not otherwise apply directly. Such emergency services may be rendered at a location other than the emergency department of a hospital, such as a behavioral health crisis service provider, as required. <a id="paragraph-222378" class="section-permalink" href="https://vacode.org/38.2-3445/#B"><i class="fa fa-link"/></a></p></section></text><history>2011, c. 882; 2020, cc. 1080, 1081; 2024, cc. 199, 360.</history><metadata></metadata></law>
