Who should I call if I have any questions about filing a complaint?

You can contact the Department at (800) 964-1784. The Department is open from 7:45 a.m. to 4:30 p.m. Monday through Friday.

What happens after the Department receives my complaint?

The Department will write to your health insurer and request a response. Your insurer must respond immediately upon receipt of the complaint. The Department will also review your complaint and take any necessary actions. The length of the process will...

How do I file a complaint?

If you are a Vermont resident and you believe your insurer did something illegal or unethical, you can file a complaint with the Department. Complaint information. Your complaint should include the following information: The name, address, email address, and telephone number...

How long with the external review process take?

The external review process should take no more than 30 days from the date the external review organization receives all the information related to your claim.[14] If you request an expedited external review, the process should take no longer than four...

How do I request an external review?

You should submit your request for an external review to the Vermont Department of Financial Regulation (“Department”).[6] You can find a copy of the external review request form here. Information. You should include the following information in your request: The name, address, and...

In which circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[3] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Vermont law, you are entitled to request an external...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or treatment but are waiting for...

How do I request an internal appeal?

If your insurer denies your claim, you have the right to an internal appeal.[1] This means you can ask your insurer to conduct a full and fair review of its decision. To appeal the denial, you should do the following: Review...

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