Administrative Code

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Virginia Administrative Code
Title 14. Insurance
Agency 10. Virginia Birth-Related Neurological Injury Compensation Program
Chapter 10. Virginia Birth-Related Neurological Injury Compensation Program Regulations

14VAC10-10-190. Requests for authorization; services outside insurance plan covered area or network.

A. In the event it is medically necessary to take an admitted claimant outside the admitted claimant's applicable insurance plan's covered service area or the primary insurance's provider network for evaluation, surgery, etc., it must be ascertained if the primary insurance plan will pay for benefits and if so, what amount it will pay. After this is determined, the Virginia Birth-Related Neurological Injury Compensation Program (Program) must be contacted for authorization prior to seeking services or the Program may determine not to pay any balance remaining on the bill for these services.

B. If an in-network provider is available for a service and an out-of-network provider is utilized, the Program will reimburse or pay only an amount equal to what the Program would have paid if an in-network provider had been utilized.

Statutory Authority

§ 38.2-5002.1 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 33, Issue 23, eff. July 10, 2017.

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