Vermont: Start Here
Beginner guide for Vermont—Vermont Health Connect, DFR external review, Act 111 PA & appeals.
Read guideState playbook
Vermont
State insurers, legislation, and appeal resources for patients and advocates in Vermont.
4 guides
Vermont Prior Authorization Law
Act 111—24-hour ack, 2-day non-urgent PA, deemed granted; no PCP PA; step therapy.
Read guideVermont Health Insurance Appeals and Grievances
First-level grievance, 180-day filing, deemed waiver, path to DFR IRO.
Read guideVermont External Review (DFR / IRO)
Binding on plan—120 days or 4 months to file, 30-day IRO / 3-day expedited.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Blue Cross Blue Shield of Vermont
- MVP Health Care
- Vermont Health Connect
- Green Mountain Care (Medicaid)
External appeals
After internal appeal, for eligible Vermont fully insured plans only.
- DFR — independent external review
- Medicaid — fair hearing