Code of Virginia § 38.2-3564. Binding nature of external review decision.
148 words·~1 min read·
/va/title-38-2/chapter-35-1/38-2-3564·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
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 .