Who should I call if I have any questions about filing a complaint?

You can contact the Virginia Bureau of Insurance at (804) 371-9691, (800) 552-7945 (in-state), or (877) 310-6560. The Bureau is open from 8:15 a.m. to 5:00 p.m., Monday through Friday.

What happens after the Bureau receives my complaint?

The Bureau will send a copy of the complaint to your health insurer and attempt to resolve the issue with them.[20] It may take up to 45 days or longer for your claim to be resolved, depending on the complexity of...

How do I file a complaint?

If you are a Virginia resident and have completed the internal and external review processes, you can file a complaint with the Bureau. Complaint information. Your complaint should include the following information: The type of insurance; The name, address, email address,...

How long with the external review process take?

The independent external review organization should provide a decision within 45 days of receipt of the request for external review.[15] The entire external review process should take no more than 60 days.[16] If you requested an expedited external review, the process should...

How do I request an external review?

You should submit your request for an external review to the Virginia Bureau of Insurance (“Bureau”) within 120 days from the date that your insurer sent you the final decision.[10] Information. You can find a copy of the request Form 216-A here....

In which circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[7] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Virginia law, you are entitled to request an external...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or treatment but are waiting for...

How do I request an internal appeal?

If your insurer denies your claim, you have the right to an internal appeal.[1] This means you can ask your insurer to conduct a full and fair review of its decision. To appeal the denial, you should do the following: Review...

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