What is the average health insurance denial rate in Vermont?

Health insurers in Vermont deny approximately 11.4% of ACA marketplace claims, which is 7.7 points below the national average of 19.1%.

How do I appeal a denied insurance claim in Vermont?

File a written internal appeal with your insurer within 180 days of the denial. If denied again, escalate to an Independent Medical Review (IMR) with the Vermont Department of Financial Regulation. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in Vermont?

Based on CMS Marketplace Transparency data, the insurers with the highest denial rates in Vermont are UnitedHealthcare, Aetna (CVS Health). See each insurer's full denial report for category-level breakdowns.

What are my rights if my insurance claim is denied in Vermont?

You have the right to a full written explanation of the denial, an internal appeal, and an external Independent Medical Review with the Vermont Department of Financial Regulation. Federal law requires insurers to respond to standard appeals within 30 days and urgent appeals within 72 hours.

Vermont Insurance Denial Report

The worst health insurers in Vermont
by claim denial rate

Vermont averages a 11.4% denial rate — 7.7 points below the national average. About 30,000 claims are denied annually.

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11.4%

Vermont avg denial rate

19.1%

National average

30,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in Vermont

In Vermont, the average health insurance claim denial rate stands at 11.4%, significantly lower than the national average of 19.1%. This translates to approximately 30,000 denials each year, affecting countless individuals and families seeking necessary medical care. While the lower denial rate is encouraging, it still represents a substantial number of patients facing obstacles in accessing their health benefits. Understanding this statistic empowers Vermonters to take action when their claims are denied, ensuring they receive the coverage they deserve.

Patients in Vermont have the right to appeal any denial of their health insurance claims. This process allows individuals to challenge the insurer's decision and seek a fair resolution. If internal appeals do not yield satisfactory results, patients can escalate their concerns to the Vermont Department of Financial Regulation, the state's regulatory body overseeing insurance practices. This agency provides a pathway for patients to voice their grievances and seek assistance in navigating the complexities of the insurance system, reinforcing their rights as consumers in the healthcare landscape.

Worst insurers in Vermont by denial rate

Source: CMS Marketplace Transparency Report 2023. In-network ACA marketplace claims only.

UnitedHealthcare

32.5% denial rate

UHC denies 32.5% of claims — 13.4 points above the national average. Their appeal overturn rate is 57%.

Specialty Medications: 43% deniedGLP-1 Medications: 41% deniedMRI / CT Scans: 35% denied

Full UHC denial report →

Aetna (CVS Health)

17.2% denial rate

Aetna denies 17.2% of claims — 1.9 points below the national average. Their appeal overturn rate is 65%.

GLP-1 Medications: 28% deniedSpecialty Medications: 22% deniedMental Health: 18% denied

Full Aetna denial report →

Your rights as a Vermont insurance patient

Vermont offers specific patient protections that empower individuals to advocate for their health insurance claims. Patients have the right to an internal appeal process, allowing them to contest denials directly with their insurer. Additionally, they can request an external Independent Medical Review if the internal appeal does not resolve the issue. The Vermont Department of Financial Regulation oversees these processes, ensuring that patients can file complaints at no cost. This free complaint filing can pressure insurers to reconsider their decisions, reinforcing the importance of patient advocacy in the healthcare system.

Vermont Department of Financial Regulation
https://dfr.vermont.gov

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How to appeal a denial in Vermont

1
Request the denial in writing
Ask your insurer for the specific clinical criteria and coverage policy they used to deny you. They are legally required to provide it within 30 days.
2
File your internal appeal
Send a written appeal to your insurer within 180 days. Cite your doctor's clinical documentation, relevant medical guidelines, and Vermont insurance law. A well-written appeal citing specific laws wins over 80% of the time.
3
Escalate to the state if denied again
If your internal appeal is denied, file an Independent Medical Review (IMR) with the Vermont Department of Financial Regulation. This is free and decided by independent clinicians. Their decision is often binding.
4
Use disputes.health to generate your letter
Our agents generate a clinic-grade appeal letter in under 15 minutes — citing your state's laws, relevant medical guidelines, and your specific situation. We then submit it to your insurer for you.

How to appeal a denial →GLP-1 denial guide →Mental health denial guide →All public resources →

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Over 80% of properly filed appeals are approved. We generate your complete appeal letter, citing Vermont insurance law, in under 15 minutes.

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The worst health insurers in Vermontby claim denial rate