4-5 Vt. Code R. 4:5 - Requests for independent external review under the Department of Financial Regulation regulations

“Requests for independent external review under the Department of Financial Regulation regulations”

An insured may obtain independent external review of an appealable decision. The right to an independent external review is contingent on the insured’s exhaustion of the health insurer’s internal grievance process unless the health insurer waived the internal grievance process. The insured must file a written request to initiate an independent external review within 120 days or 4 months, whichever is longer, upon receipt of written documentation of the health benefit plan’s final grievance decision and notice of appeal rights, the insurer waived the required grievance process, or the insurer is deemed to have waived the grievance process by failing to adhere to grievance process time requirements. The Department of Financial Regulation must confirm the request for an independent external review within 10 business days.