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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 telephone number of the patient;
  • The name, address, and telephone number of the insurance company;
  • The name of the person at the insurance company involved with your appeal;
  • Subscriber or member number and insurance claim or reference number;
  • Brief description of decision in dispute; and
  • The name, type of provider, address, and telephone number of your health care provider.

Filing fee. You must submit a $25 filing fee by check or money order with your request. The fee can be waived for financial hardship.[7] If you believe you have a financial hardship, you should complete the “Request to Reduce or Waive Filing Fee” section of the external review request form (bottom of page 2 of the form).[8] If you complete that section, do not submit the filing fee.[9]

Supporting documents. You should include the following documents with your request:

  • A copy of the denial letter from your health insurer; and
  • Any new information and documentation that you had not included with your prior request for an internal appeal.

Submitting a standard external review. If you are requesting a standard external review, you should submit your request to the following address:

David Martini, Esq.
Director External Appeals Program
Vermont Department of Financial Regulation
89 Main Street
Montpelier, VT 05602[10]

Submitting an expedited review. If you are requesting an expedited external review, you should contact the Department at (800) 964-1784 or (802) 828-3302. If it is an emergency, you can contact the External Appeals answering service at (888) 236-5966 after hours.[11]

You must file your written request for an external review within 120 days or four months, whichever is longer, from the date that your insurer sent you the final decision.[12] You should contact Consumer Services at (800) 964-1784 or (802) 828-3302 as soon as possible after receiving an adverse decision from an internal appeal.[13]