Patients' Rights/Legal Forms

Appeals

Request for Appeal - CareFirst Members who are Virginia Residents

If you are a Virginia resident with CareFirst health care coverage, and you wish to file an external appeal for a denied claim, you may do so with the Commonwealth of Virginia. This process does not apply to residents covered under self-insured accounts.

To access appeals forms, you may visit their website or use the Virginia request for external claim forms below:

Virginia External Review Request Form (doc)
Virginia External Review Request Form (pdf)