Health Care Advocate Project

The Office of the Health Care Advocate (HCA) helps Vermont consumers with a broad range of problems and questions related to health care services and health insurance. We frequently help individuals get onto insurance plans, untangle thorny problems, and intervene when an insurer improperly denies medical treatment. In many cases, we empower consumers by giving advice and education that enables them to better understand and resolve their health care issues and questions.

We act as a voice for consumers in health care policy matters before the Vermont legislature and as their advocate before government agencies that oversee state insurance and other health care programs.

We represent the public in matters before the Green Mountain Care Board. In rate review hearings for commercial insurance companies, we argue for affordable insurance rates. In other matters before the Board, including hospital budget requests and Certificates of Need, we advocate to ensure that providers maintain or improve quality of care and avoid unnecessary costs.

Hope for a Healthier Future

Randall called the HCA because Medicaid had refused to cover a life-changing medication. He suffers from Hepatitis C, and his doctor had prescribed a new medication that has the potential to cure, rather than simply treat, the disease.

Medicaid said it wouldn't cover the medication because Randall’s disease was not advanced enough. The HCA advocate explained Randall’s appeal rights and helped him request a Fair Hearing. The advocate also talked to Randall’s provider, researched the new medication, and helped develop Randall’s argument and strategy for the hearing.  

At the hearing, Randall argued that he should be allowed to get the new medication because it offered the possibility of curing his disease and that he should not be required to wait until his liver was further damaged to attempt to cure the disease. He prevailed at the hearing, and the decision to deny the medication was reversed. Randall immediately picked up the medication and began his course of treatment, with hope for a healthier future.

Name(s) and some details have been changed to protect anonymity and confidentiality.

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