External review in Vermont: deadline, cost and how to ask
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.
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.
Step 2: Outside review in Vermont
- Program
Independent External Review (Healthcare External Appeal)
- Who runs it
- Vermont Department of Financial Regulation (sends the case to an independent review organization): Health insurance regulated by DFR
- Deadline to ask
4 months
You must ask within 120 days or 4 months, whichever is longer, after you receive the insurer's final denial letter. A request counts as on time if DFR got a phone call or written inquiry about your case before the deadline and you confirm it on the DFR form within 10 working days.
- The deadline runs from
The date you receive the insurer's final grievance decision and notice of appeal rights (or the date the insurer waived, or is treated as having waived, its grievance process)
- Do I have to appeal to my plan first?
You must finish the insurer's first-level internal appeal first. You do not have to if the insurer waived the grievance process or missed its grievance deadlines. For an urgent case you can ask for expedited external review at the same time as an urgent internal grievance.
- How long the review takes
Standard: 30 days
- Cost
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. The $25 is refunded if the reviewer overturns the denial.
- What can be reviewed
Denials because the service is not medically necessary; because your choice of provider is limited in a way your contract or the law does not allow; because the service is experimental, investigational or an off-label drug use; or a medically based decision that your condition was pre-existing, where the service is a covered benefit.
- Is the decision final?
The decision is binding on the insurer and on you, except where either has other remedies under federal or Vermont law.
- How to ask
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. If you email or fax, mail the check separately (or ask about ACH). Do not send medical records by regular email; DFR staff will tell you how to send them securely. You can ask for a phone conference with the reviewer and your insurer. DFR collects documents from you and the insurer and sends them to the reviewer.
Law: 8 V.S.A. 4089f; DFR Rule H-2011-02 (Revised), Sections 5, 6, 7
- Forms and online request
- Phone
802-622-4423 (business hours); urgent after hours 802-232-2878
Write my appeal: free letters
Sources
The official sources for Vermont are listed on the Vermont page.