The House of Lords voted 330 to 262 against an amendment which would have referred parts of the bill to a special select committee.
Health Minister Earl Howe said it could be altered further to address concerns, but any hold-up could "prove fatal".
Peers have also rejected an amendment to block the bill altogether.
That amendment was put forward by Labour peer and former GP Lord Rea, who argued it was never a manifesto commitment by either the Conservatives or the Liberal Democrats.
It was rejected by 354 votes to 220.
The Health and Social Care Bill - which will now proceed to a normal committee stage in the Lords - would increase competition and put GP-led groups in control of buying care in their areas.
Ministers say the changes are vital to help the NHS cope with the demands of an ageing population, the costs of new drugs and treatments and the impact of lifestyle factors, such as obesity.
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