Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Virginia program

An independent review of an insurance denial

An outside reviewer can reconsider a denial by a health plan Virginia regulates.

What it is

An outside reviewer can reconsider a denial by a health plan Virginia regulates.

A final refusal from the insurer is not always the last word. On a plan Virginia regulates, an independent reviewer decides and the plan has to follow it; Virginia names cancer as a reason to skip the plan's own appeal and to get a 72-hour decision. A plan where the employer pays its own claims uses a federal route unless it asks the state to review; one question to HR settles which.

Eligibility rules
  • This chapter covers health carriers regulated by Virginia. Self-insured plans are excluded, although one may itself request standard review.
  • The state external-review request is due within 120 days after you receive the rights notice. Keep the notice and arrival date; other appeal deadlines can differ.
  • If the employer is based in another state, its plan may follow that state's rules instead; HR can say which state regulates the policy.
What you get
  • A standard medical-review decision within 45 days after receipt of the review request.
  • Expedited review when the applicable urgent-review conditions are met.
What the rules cover
  • The independent reviewer’s decision binds the plan under the state process.
If you decide to apply
  1. Ask the plan for the denial and notice of the right to external review.
  2. Ask the oncology team for a letter explaining the treatment and harm from delay, and discuss a written request to the State Corporation Commission.

An independent review organization assigned by the State Corporation Commission · Official page ↗

If you decide to apply
  • The oncologist explains why the treatment is needed and how a delay would affect your child.
Good to know

A qualifying cancer-treatment denial can bypass the plan’s internal appeal. The SCC and clinical team can identify the correct route.

Other details
  • The request goes to the State Corporation Commission on its external-review form, with a signed release; the help line is 877-310-6560. A standard review is decided within 45 days and an urgent one within 72 hours. A cancer-treatment denial can go straight to outside review without finishing the plan's own appeal.
Official sources
Ask your social worker

“If treatment is denied, could our case use an urgent outside review? Could you help check the deadline and ask the oncologist for the supporting letter?”

Why I’m asking: I want to understand the review route before a delay interrupts care.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File within 120 days and ask for the urgent route.

Your social worker

The plan must give the written denial and the notice of the right to review.

The care team

The oncologist writes why the treatment is needed and what a delay would cost.

Who decides
An independent reviewer assigned by the state
Ask the care team
“The plan has refused this. Can you write the letter for an urgent outside review, saying why it is needed now and what a delay would mean?”

How to apply

First step: Ask the plan in writing for the denial letter and the notice of the right to external review, and ask the oncologist for an urgency letter.

  1. Ask the plan for the written denial and the notice of the right to external review.
  2. Ask the oncology team for a letter on urgency the same week.
  3. File for an urgent review and say the word cancer in the request.

Official application / program page ↗

Where it starts: Ask the plan for the notice of the right to external review, then file in writing with the Commission within 120 days.

What to gather

  • The denial letter with its date
  • The oncologist's letter on urgency
  • The plan certificate or booklet

How long: 45 days for an ordinary decision, no more than 72 hours for an urgent one.

What a yes looks like

The reviewer overturns the denial and the plan has to cover it.

What a no looks like, and the next move

The reviewer agrees with the plan. Ask the team about a different approved route, and ask the hospital about assistance for the cost.

Watch out

  • Do not sit out the internal appeal: a cancer denial can skip it.
  • Self-funded plans are outside the chapter, though such a plan may ask for a review itself.
  • The state's forms page could not be read; ask the plan for the notice of the right to review.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

An independent reviewer outside the plan: 120 days to file, 45 days to decide, and no more than 72 hours when the case is urgent.

  • $120 — Days to ask the state for an outside review
  • $45 — Days for an ordinary outside decision
  • $72 — Hours for an urgent outside decision

Legal protection: A cancer denial is exempt from having to exhaust the plan's own appeal first · Cancer is named among the grounds for an urgent review · The reviewer's decision binds the plan

What it costs the family: None.

The eligibility facts, as published

Plans
health carriers regulated by Virginia; self-insured plans are excluded, though such a plan may itself request a standard review
Deadline
120 days after the notice of the right to external review
Cancer
no need to exhaust the internal appeal; expedited review available

The trap: People wait out the plan's internal appeal because a form says to. For a cancer denial the law lets you go straight to the state.

Where I read this

← Back to your options