Code of Virginia · § 38.2-3407.23 — Prohibited restrictions on in-network referrals

A. As used in this section:

"Carrier" has the same meaning as provided in § 38.2-3407.15. "Carrier" includes any entity administering a policy or plan providing health insurance coverage to state employees pursuant to § 2.2-2818.

"Health plan" has the same meaning as provided in § 38.2-3407.15. "Health plan" includes any policy or plan providing health insurance coverage to state employees pursuant to § 2.2-2818.

"In-network" means a provider that has contracted with a carrier or a carrier's contractor or subcontractor to provide health care services to enrollees and be reimbursed by the carrier at a contracted rate as payment in full for the health care services, including applicable cost-sharing requirements.

B. No carrier, in the provision of individual or group accident and sickness insurance, including any health benefit plan, shall prohibit an in-network provider from referring any enrollee or specimen to any in-network clinical laboratory or in-network pathology service provider under the terms of the health plan unless such referral would constitute a violation of the Practitioner Self-Referral Act (§ 54.1-2410 et seq.) or 42 U.S.C. § 1320a-7b.

C. The Commission shall have no jurisdiction to adjudicate individual controversies arising out of this section.