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Bill

HB 424

Health insurance; definitions, prohibited restrictions on in-network referrals.

2026 Regular Session Introduced by Bonita Anthony and 7 co-sponsors

Virginia law prohibits health insurers from restricting patient referrals to out-of-network specialists, expanding choice but potentially raising insurance costs.

Fiscal Impact Statement from State Corporation Commission (HB424)
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Bill Summary · HB 424

Legislative bill overview

HB 424 modifies Virginia's health insurance regulations to prohibit insurance plans from restricting patients' ability to receive referrals to out-of-network specialists. The bill redefines relevant insurance terms to strengthen patient choice in specialist care while maintaining in-network cost structures.

Why is this important

Insurance referral restrictions can limit patient access to specialized care and force patients to either accept in-network providers or face significantly higher out-of-pocket costs. This bill addresses a common patient complaint about insurance plans blocking or discouraging referrals to specialists outside their network, potentially improving healthcare access and transparency.

Potential points of contention

  • Cost implications: Insurers may argue that allowing unrestricted out-of-network referrals increases plan costs, which could be passed to consumers through higher premiums
  • Definition clarity: The bill's specific prohibitions on "restrictions" may be subject to interpretation disputes between insurers and regulators regarding what constitutes an unlawful barrier
  • Network adequacy standards: Questions remain about how this interacts with existing network adequacy requirements and whether plans must maintain robust in-network specialist panels

Compiled from official sources — confirm details with the bill’s official record.

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