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Bill

SB 745

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

2026 Regular Session Introduced by Kannan Srinivasan

Virginia bill prohibits health insurers from blocking self-referrals to in-network specialists, expanding patient access to covered specialty care without gatekeeper approval.

Approved by Governor-Chapter 139 (effective 7/1/2026)
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Bill Summary · SB 745

Legislative bill overview

SB 745 prohibits health insurance plans from restricting patients' ability to obtain referrals to in-network specialists. The bill prevents insurers from requiring patients to seek referrals exclusively through primary care physicians or other gatekeeping mechanisms when specialty care is available within the plan's network.

Why is this important

In-network referral restrictions can delay specialty care access and limit patient choice, potentially forcing patients to navigate bureaucratic processes or switch providers. This bill aims to streamline access to covered specialist services while keeping costs within the network, balancing patient autonomy with insurance plan efficiency.

Potential points of contention

  • Cost implications: Insurance companies may argue that direct specialist access without gatekeeping could increase utilization and premiums, though supporters counter that in-network care should already be cost-controlled
  • Primary care physician role: The bill may reduce primary care coordination and continuity of care benefits, as PCPs traditionally screen referrals for medical necessity
  • Network utilization management: Insurers lose a tool for managing specialist overutilization and ensuring appropriate care pathways, potentially affecting plan design and pricing strategies

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

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