Virginia Claims or Coverage Denials

Obtain Forms to Request External Review of Claims after Receiving an Adverse Benefit Determination

CareFirst Northern Virginia members may request an external review of any denied claims or coverage by the Virginia State Corporation Commission.

If you have CareFirst health insurance in Virginia, you may visit the Virginia State Corporation Commission website to obtain forms and resources to submit a request for an external review on claim and coverage denials occurring after July 1, 2011.

Details on what types of coverage and adverse benefit determinations are eligible for this request, as well as information on how to make the request, are located on the Virginia State Corporation Commission website.

Note: Virginia members who wish to appeal an adverse benefit decision that is related to the treatment of cancer may be entitled to an expedited external review without first exhausting the internal review process.