Filing A Complaint

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If you have a complaint about your health insurance, the Health Care Administration can help. Health insurance includes HMO, PPO, indemnity, Catamount Health, disability income, Medicare supplement, long-term care, student insurance, dental insurance, accident and other disease-specific insurance (like coverage for cancer).

We encourage you to call our Consumer Services Unit at 1-800-631-7788 to discuss your situation. We can help you determine whether a formal complaint to the Department is the best way to address the matter.  We can also evaluate whether you may qualify for an Independent External Review.

What we CAN do:

  • Suggest actions or procedures that may resolve your insurance complaint.
  • Review the complaint information and take action if there is non-compliance with applicable laws and regulation.
  • Provide information about health insurance and health insurance laws.
  • Verify that a health insurance product and premium rates are approved for use in Vermont.
  • Explain the provisions of your insurance policy.

If you feel your health insurance claim for a medical-based service was wrongly denied, we can determine if the denial qualifies for an independent external review.

What we CANNOT do:

  • Act as your advocate or lawyer or give you legal advice.
  • Decide legal disputes that must be handled through the courts.
  • Decide medically-based disputes in cases not eligible for an independent external review.
  • Force an insurer to satisfy you if no laws have been violated.

If you have discussed your problem with Health Insurance Consumer Services and want to file a complaint with the Department, you will need to complete a complaint form.

Note: it’s very important to remember to complete all sections of the form, including the "Consent to Release Information”.  Please do NOT e-mail your complaint to BISHCA.  We cannot guarantee the confidentiality of e-mail transmissions.

To send the complaint form and any attachments to the Department by mail or fax:

By mail:

Health Insurance Consumer Services

Division of Health Care Administration

89 Main Street,

Montpelier, VT 05620-3101

By fax:  802-828-1446

 

How long will the investigation take? We will keep you updated and advise you on our findings.  Please be patient.  A thorough investigation may take six to eight weeks or longer.