Health insurance or Medicaid said no in Vermont? Deadlines and free help

In Vermont, your health plan is regulated by Vermont Department of Financial Regulation (DFR), Insurance Division, if it is a state-regulated plan.

Vermont runs its own independent review of denials: Independent External Review (Healthcare External Appeal). You generally have 4 months to ask for it.

External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

Green Mountain Care

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (Vermont Health Connect) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

Checked against official sources: October 30, 2026.

Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.

How long do I have in Vermont?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
4 months
Hearing deadline
90 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
120 days
Appeal deadline – Vermont Health Connect
90 days

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

DFR can only address complaints about insurance companies, agents and adjusters regulated in Vermont. Vermont Medicaid (Green Mountain Care) decisions are appealed to the Department of Vermont Health Access and the Human Services Board instead.

Step 1: Appeal to your plan in Vermont

What it is called: First-level internal appeal (grievance) with your insurer

You must complete your insurer's first-level internal appeal before you can ask DFR for an external appeal. Your insurer must send a DFR-approved notice of your Vermont appeal rights with each denial.

Law: DFR Rule H-2011-02 (Revised), Section 5(A)

All the details →

Step 2: Outside review in Vermont

Independent External Review (Healthcare External Appeal)

Deadline to ask: 4 months.

All the details →

Urgent care in Vermont: faster decisions

Outside review

Reviews are expedited if the grievance had to be expedited by law, if you or your doctor call the case an emergency or urgent, or if DFR decides so. The reviewer must decide within 3 days after receiving the request. For an emergency outside business hours, call the External Appeals answering service at 802-232-2878. If you are getting ongoing care in a facility or an approved course of treatment and you ask for expedited review within 24 hours of getting the final grievance decision, the insurer must keep covering the care until the decision and a safe discharge or transition plan.

Law: 8 V.S.A. 4089f; DFR Rule H-2011-02 (Revised), Sections 5, 6, 7

Standard: 30 days

Medicaid

If waiting would hurt you, ask for a fast (expedited) appeal the same ways you file. Most expedited appeals are decided within 7 working days; Medicaid for people who are aged, blind or disabled and long-term care appeals may take longer.

Marketplace

If waiting would hurt you, ask for an expedited appeal. Most expedited appeals are decided within 7 working days.

Law: 45 CFR 155.520

Complaints about your plan in Vermont

If your plan is not giving the benefits or coverage it must, such as unexpected out-of-pocket costs or pharmacy benefit problems, you can file a complaint with DFR online, in person or by mail. There is a separate form for complaints about a pharmacy benefit manager denying a prescription.

dfr.vermont.gov

Medicaid (Green Mountain Care (Vermont Medicaid and Dr. Dynasaur)) denials in Vermont

Who holds the hearing: Vermont Human Services Board.

Hearing deadline: 90 days

All the details →

Marketplace decisions in Vermont

Marketplace

Vermont Health Connect · 1-855-899-9600

Appeal deadline

90 days

The date of the decision

How to appeal

Log in to your Vermont Health Connect account and click My Requests, call Customer Support at 1-855-899-9600, send a letter to the Human Services Board, 6 Baldwin Street, Suite 305, Montpelier, VT 05633-4301, or email AHS.DVHAHealthCareAppealsTeam@vermont.gov with "Appeal" as the subject. Keep paying your premium during the appeal or you lose your insurance.

Faster appeal

If waiting would hurt you, ask for an expedited appeal. Most expedited appeals are decided within 7 working days.

Coverage while you appeal

When you appeal, tell Vermont Health Connect you want "continuing benefits" so your coverage stays the same during the appeal. You may have to pay back extra advance premium tax credits when you file taxes.

Law: 45 CFR 155.520

Other rights in Vermont

Care continues during an urgent external review

If your ongoing care in a facility or an approved course of treatment is being cut off, and you ask DFR for an expedited external review within 24 hours of getting the insurer's final grievance decision and appeal rights notice, the insurer must keep covering the care until the review decision is issued and a safe discharge or transition plan is approved.

Law: DFR Rule H-2011-02 (Revised), Section 7(A)(4)

Phone conference with the reviewer

When you file for external review you can ask for a phone conference so you (and your doctor) can discuss the case with the independent reviewer and your insurer. The reviewer must give your treating provider's clinical information equal or greater weight than the insurer's guidelines.

Law: DFR Rule H-2011-02 (Revised), Section 6(B), 6(D)

Prior authorization limits

Health plans may not require prior authorization for services ordered by a primary care provider, except prescription drugs and out-of-network care. An urgent prior authorization request must be answered within 24 hours, and a non-urgent one within 2 business days. An approval stays valid for the length of the treatment or one year, whichever is longer. If you change plans while stable on an approved treatment, the new plan must cover it without restriction for at least 90 days.

Law: Act 111 of 2024 (H.766), Secs. 4, 9; Act 18 V.S.A. 9418b

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Vermont and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Vermont

Good to know in Vermont

  • Vermont charges a $25 external review filing fee (at most $75 a year), waived for hardship and refunded if you win.

    Law: DFR Rule H-2011-02, Section 5(H)

  • Vermont gives 120 days or 4 months, whichever is longer, to ask for external review.

    Law: DFR Rule H-2011-02, Section 5(D)

  • Vermont's expedited external review must be decided within 3 days.

    Law: DFR Rule H-2011-02, Section 7(A)(3)

Changes in 2024–2026

January 1, 2025: Act 111 of 2024 (H.766) took effect for health plans issued on or after that date: no prior authorization for most services ordered by primary care providers, a 24-hour limit for urgent prior authorization decisions (plans needing technology changes had until January 1, 2026), longer-lasting approvals, a 90-day transition for people who change plans, and new step-therapy exception rules.

Questions about appeals in Vermont

How long do I have to appeal a health insurance denial in Vermont?

Use the deadline on your denial notice. Federal rules give at least 180 days for most plans. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.

How do I get an outside (external) review in Vermont?

Independent External Review (Healthcare External Appeal). Complete the DFR External Appeals Application (Request for Independent External Review of a Healthcare Decision), sign and date it, and send it with a copy of the insurer's final denial letter and the $25 fee (or tell DFR you have a financial hardship). Mail it to Vermont Department of Financial Regulation, External Appeals, 89 Main Street, Montpelier, VT 05602, or fax it to 802-828-5593, or email it to the contact listed on DFR's Healthcare External Appeal page.

Is outside review free in Vermont?

The filing fee is $25, with a limit of $75 a year. DFR waives or reduces it for financial hardship, including for people eligible for food stamps, TANF, General Assistance, Medicaid, SSI, fuel assistance or unemployment assistance; no tax forms are needed.

How long do I have to ask for a Medicaid fair hearing in Vermont?

90 days. The date of the decision

Can I keep my Medicaid benefits while I appeal in Vermont?

When you appeal, say that you want "continuing benefits." For Medicaid or Dr. Dynasaur you must appeal before the date your coverage ends or the date your payment changes. If you lose, you may have to pay back the cost of care you got that you did not qualify for.

How do I appeal a Marketplace decision in Vermont?

Log in to your Vermont Health Connect account and click My Requests, call Customer Support at 1-855-899-9600, send a letter to the Human Services Board, 6 Baldwin Street, Suite 305, Montpelier, VT 05633-4301, or email AHS.DVHAHealthCareAppealsTeam@vermont.gov with "Appeal" as the subject. Keep paying your premium during the appeal or you lose your insurance.

Not about a denied claim?

Nearby states

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