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Important Message: Open Enrollment for 2025 health insurance plans is here. You can now enroll in a new plan or change plans. Sign up by December 15 to have insurance starting January 1, 2025! 

Appeals

You have the right to appeal a decision you think is wrong

To appeal means to ask for a decision to be looked at again. You can tell someone who did not make the decision why you think it's wrong. This is called a fair hearing. The fair hearing will be in front of the Human Services Board. Learn more about the Human Services Board.

Important! Once you appeal a decision, our staff are not allowed to discuss your case. Only the Health Care Appeals Team can communicate with you until the appeal is resolved.

There are four ways to file an appeal: 

Is there a deadline to appeal? 

Yes, you must appeal within 90 days. The 90 days start with the date of the decision. After you appeal, you will get a letter from the Human Services Board. It will tell you what to do next. We must decide your appeal within 90 days, in most cases.

What if you need health care right away? 

If it would hurt you to wait for an appeal, ask for a fast appeal. A fast appeal is called "expedited."  We decide most expedited appeals in 7 working days. We may take longer if your appeal is about 1) Medicaid for people who are aged, blind, disabled; or 2) long term care. We decide these appeals as quickly as possible. See above for the four ways to file an appeal.

Can someone speak for me in my appeal? 

Yes. You can speak for yourself. Or you can have a friend, relative or someone else speak for you. You can have a lawyer speak for you.

Where can I get help with my appeal? 

You can ask for free advice or a lawyer from Vermont Legal Aid. Call Vermont Legal Aid's Office of the Health Care Advocate at 1-800-917-7787.

Can I keep my coverage while I appeal?

Yes. When you appeal, tell us you want "continuing benefits." This means you want your health coverage to stay the same during the appeal. Do you have Medicaid/Dr. Dynasaur? Then you must appeal before the date it ends or the date your payment changes.

Important! What if you get too much federal advance premium tax credits (APTC)? You may have to pay it back when you file your taxes.

Do I have to pay my premium during my appeal? 

Yes. If you don’t, you lose your health insurance.

What happens if I lose the appeal?

Did you get health care you did not meet the rules for? Then you may have to pay us back. It may also change health insurance for others in your household.

What if my health coverage stops and I win my appeal? 

We will start your health coverage again. Most of the time, it will go back to the date it ended. If you paid too much for a premium, we will pay you back.

Timely eligibility decisions from Vermont Health Connect

Vermont Health Connect must decide your eligibility no later than 30 days after your application date, unless:

  • A delay is caused by an emergency or a problem beyond Vermont Health Connect’s control.
  • You need more time to give us the information we need to determine your eligibility.

If you do not get a decision within 30 days, you can call Vermont Health Connect at 1-855-899-9600 for more information or to request a fair hearing.

Feedback and Complaints

You can give us feedback about our processes, how our staff treat you, or how our systems work for you.

You can make a complaint to address a general process, program or staff issue. We do our best to help with complaints and will work with you to resolve the issue.

Here’s how you can give us feedback or make a complaint: