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 review for

  • Any denial that involves medical judgment where you or your provider may disagree with the health insurance plan
  • Any denial that involves a determination that a treatment is experimental or investigational
  • Cancellation of coverage based on your insurer’s claim that you gave false or incomplete information when you applied for coverage.[4]

You can also skip the internal appeal process altogether and request an expedited external review if your medical situation is urgent and waiting would jeopardize your life or ability to function.[5]