Appeals, Fair Hearings and Grievances

Appeal:

To appeal means to ask the Department to review its decision.
You must ask for an appeal within 60 calendar days of the decision.
If the decision you received is to reduce or end benefits or services you are currently getting and you want your benefits or services to continue during your appeal, you must request this at the time you make your appeal.  If you get benefits or services during your appeal, you may be asked to pay for them if the appeal is not decided in your favor.

Emergency expedited appeals may be requested in situations when you believe that the time for a regular appeal could risk your life or health.

Fair Hearing:

A fair hearing is a legal process where the Human Services Board will hear your case and decide if we made the right decision.

  • You must go through the internal appeal process before you can ask for a fair hearing. 
  • You must ask for a Fair Hearing within 120 days from the date of the appeal decision letter.
  • If you are told that your benefit is changed because of a change in federal or state law, an internal appeal will not be granted, but you may ask for a fair hearing.
  • If the decision you received is to reduce or end benefits or services you are currently getting and you want your benefits or services to continue during your fair hearing, you must request this at the time you file your fair hearing request.  If you get benefits or services during your fair hearing, you may be asked to pay for them if the fair hearing is not decided in your favor.

Grievance:

A Grievance is a complaint about things other than actions, like the location or convenience of visiting your health care provider, the quality of the health care provided, or being adversely affected after exercising your rights. If you can’t work out your differences with your provider, you may file a grievance by calling the Customer Support Center or the department that is responsible for the provider or the quality of the service. That department will send you a letter about how they can address it within 90 days.

If you filed a grievance and are not happy with the way it was addressed, you may ask for a Grievance Review. A neutral person will review your grievance to be sure that the grievance process was handled fairly. You will get a letter with the results of the review.
Neither you nor your provider shall be subject to retribution or retaliation for filing a grievance or an appeal with Green Mountain Care. If you need help with any part of the grievance or appeal process, staff members of Green Mountain Care can help you – just ask.

Who to Contact:

Please call the Vermont Health Connect, Green Mountain Care Customer Support Center at 1-800-250-8427 (TDD/TTY) 1-888-834-7898 for more information or to file an appeal, fair hearing, or a grievance.

You can ask a family member, a friend, or another person (such as a provider) to help you request an appeal or a fair hearing, or to file a grievance. You will need to tell the State that you want this person to act on your behalf. That person can also represent you during the process. If you do not know what to do for any of these requests or for help with any of the steps, please call the Customer Support Center at 1-800-250-8427.

For legal assistance or help solving a problem, call your local Vermont Legal Aid Office at 1-800-889-2047 or the Office of Health Care Advocate at 1-800-917-7787. Their services are free.

 

 

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Department of Vermont Health Access

280 State Drive
Waterbury, Vermont 05671-1010
Phone: 802-879-5900
Fax: 802-241-0260

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Hours of Operation: Monday-Friday (Excluding Holidays) 7:45am - 4:30pm

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Kelly Provost
DVHA Public Records Officer
AHS.DVHALegal@Vermont.gov
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