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HB 481

Prior authorization; requiring physician review for denial.

2026 Regular Session Introduced by Elizabeth Bennett-Parker and 4 co-sponsors

HB 481 mandates physician review approval for all prior authorization denials to ensure clinical judgment guides insurance coverage decisions in Virginia.

Approved by Governor-Chapter 925 (effective 7/1/2026)
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Bill Summary · HB 481

Legislative bill overview

HB 481 requires that any denial of prior authorization for medical treatment must be reviewed and approved by a physician rather than determined solely by administrative or non-medical personnel. The bill aims to ensure clinical judgment guides coverage decisions for healthcare services in Virginia.

Why is this important

Prior authorization denials can delay or prevent patients from accessing necessary medical care, and this requirement addresses concerns that insurance companies may deny care based on cost considerations rather than medical necessity. The bill has already passed the House unanimously (97-0), indicating broad bipartisan support for physician involvement in denial decisions.

Potential points of contention

  • Implementation costs: Requiring physician review for all denials may increase administrative expenses for insurers, which could be passed to employers or consumers through higher premiums
  • Timeline concerns: Adding a physician review step could further delay already time-sensitive prior authorization decisions, potentially worsening patient access rather than improving it
  • Definition ambiguity: The bill's language on what constitutes a "denial" and when physician review is required may need clarification to prevent disputes over scope and application

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

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