A new measure from state Sen. Jeremy S. McPike is intended to enhance fairness and strengthen transparency in dealings between health insurance providers and carriers, according to the Virginia State Senate.
The legislation, filed as SB164 on Jan. 14, 2026, during the 2026 regular session, is officially described as: “Health insurance; ethics and fairness in carrier business practices, downcoded claims.”
The summary below draws on the actual bill language, with explanations added to clarify main points.
Essentially, this proposal revises the state’s fair business practice requirements for transactions between carriers and healthcare providers, particularly addressing downcoded and retroactively denied claims. It stipulates that any downcoding undergo a review by a licensed clinician, requires carriers to send comprehensive electronic notifications about downcoding and allow no less than 180 days for providers to appeal, and permits batch appeals for similar cases. Expanded electronic communications for claim defect and retroactive denial notifications must be in place by Jan. 1, 2026. The measure also sets out dispute resolution and remedies for providers, and requires fee-free payment choices and the use of online tools verifying coverage starting July 1, 2025.
The initiative was sponsored by Sen. Jeremy S. McPike (Democrat-29th District) together with Sen. Bill DeSteph (Republican-20th District).
Since the start of the session, McPike has submitted an additional 20 pieces of legislation.
He graduated from George Mason University in 1997 with a Bachelor of Arts.
McPike, a Democrat, has served in the Virginia State Senate since 2016, where he represents the 29th district, succeeding former Sen. Charles Colgan.
In Virginia, the legislative procedure starts when a lawmaker introduces a bill in either the House of Delegates or the Senate, followed by its referral to one or more committees for review and potential amendments. If cleared by committee, the legislation advances to chamber-wide discussion and voting in both the House and Senate. Once both pass the bill, it goes to the governor’s desk for approval, veto, or automatic enactment without a signature. The state’s General Assembly gathers each year beginning the second Monday in January for its regular session. Legislators file hundreds of bills per session, though only some become statutes.
| Patron(s) | Bill Number | Date Introduced | Short Description |
|---|---|---|---|
| Jeremy S. McPike and Bill DeSteph | SB164 | 01/14/2026 | Health insurance; ethics and fairness in carrier business practices, downcoded claims. |
| Jeremy S. McPike, Barbara A. Favola, Jennifer B. Boysko, Kannan Srinivasan, Russet Perry, and Saddam Azlan Salim | SB74 | 01/14/2026 | Affordable housing; local zoning ordinance authority. |
| Jeremy S. McPike and Christie New Craig | SB122 | 01/14/2026 | School boards; student diabetes care & management in schools, division wide plan required. |
| Jeremy S. McPike and Russet Perry | SB138 | 01/14/2026 | PFAS monitoring; DEQ to require for industrial wastewater source, publicly owned treatment works. |
| Jeremy S. McPike | SB139 | 01/14/2026 | Income tax, state; subtraction for long-term capital gains from sale of principal residence. |
| Jeremy S. McPike | SB140 | 01/14/2026 | Fire Programs, Department of; development of mental health awareness training. |
| Jeremy S. McPike | SB148 | 01/14/2026 | Income tax, state; subtraction for tax, military retirement benefits, uniformed services. |
| Jeremy S. McPike | SB149 | 01/14/2026 | State-facilitated IRA savings program; various changes to the program. |
| Jeremy S. McPike | SB165 | 01/14/2026 | Contracts; retainage bonds permitted in construction contracts, effective clause. |
| Jeremy S. McPike | SB166 | 01/14/2026 | Insurance; contingent deferred annuities, nonforfeiture benefits. |
| Jeremy S. McPike | SB170 | 01/14/2026 | Protection of employees; covenants not to compete, discharged employees. |
| Jeremy S. McPike | SB256 | 01/14/2026 | Appliance minimum energy and water conservation standards; requirement of manufacturers. |
| Jeremy S. McPike | SB321 | 01/14/2026 | Abandonment of highway; section of the secondary state highway system, local authority. |
| Jeremy S. McPike and Jennifer D. Carroll Foy | SB324 | 01/14/2026 | Virginia Public Procurement Act; additional public works contract requirements. |
| Jeremy S. McPike | SB326 | 01/14/2026 | Virginia Public Procurement Act; cooperative procurement. |
| Jeremy S. McPike and Kannan Srinivasan | SB371 | 01/14/2026 | Electric utilities; electric demand flexibility programs, high energy demand customers, report. |
| Jeremy S. McPike, Angelia Williams Graves, Jennifer D. Carroll Foy, Kannan Srinivasan, and Saddam Azlan Salim | SB388 | 01/14/2026 | Affordable housing; religious organizations and other nonprofit tax-exempt properties. |
| Jeremy S. McPike and Angelia Williams Graves | SB443 | 01/14/2026 | Siting of battery energy storage projects; commercial solar photovoltaic generation facilities. |
| Jeremy S. McPike, Adam P. Ebbin, Jennifer B. Boysko, Kannan Srinivasan, Saddam Azlan Salim, and Scott A. Surovell | SB446 | 01/14/2026 | Limited-duration licenses, driver privilege cards, and permits; validity periods for documents. |
| Jeremy S. McPike | SB487 | 01/14/2026 | Electric cooperatives; authorized to establish and implement a virtual power plant program. |
| Jeremy S. McPike | SB591 | 01/14/2026 | Income tax, state; free tax filing program for individuals |
Details in this article came from the Virginia State Senate. Complete source data is available here.
