Insurers, health-care advocate debate limits on rate-review questions in Vermont

Representatives of Blue Cross and Blue Shield of Vermont and MVP Health Care told a committee that they do not oppose the Office of the Health Care Advocate asking questions directly of insurers, but they urged guardrails — including limiting questions to those relevant to the rate filing and to the review criteria and constraining timelines or counts.

Sarah Teachout, representative of Blue Cross and Blue Shield of Vermont, said the company is willing to answer questions but wants them limited to matters "directly related to the file" and described the current process as "administratively expensive and burdensome." Teachout noted insurers, the Green Mountain Care Board and the advocate all build the costs of review into premiums and urged the panel to avoid "really unreasonable and excessive" demands that would add legal and actuarial expense.

Jordan Estee, representing MVP Health Care, said the rate-review process already requires large cross‑functional efforts and can take weeks to answer complex inquiries. "We're neutral on the bill," Estee said, adding that insurers would support clarifying that questions be narrow and specific to the rate filing or that the board provide additional time to respond.

An unnamed representative of the Office of the Health Care Advocate said the office has managed cooperative informal resolution with carriers in recent years but argued that changing the submission route should not "tie an arm behind our back." The advocate proposed a limit modeled on the federal civil‑procedure rule: allow the advocate to submit, within 30 days of a filing, no more than 25 written questions including subparts that are "relevant to the rate filing and to the review criteria." The advocate also cited a 2018 example when the office submitted 35 questions with 52 subparts.

Charlie (staff member), speaking for board staff, said carriers would still be able to object to questions and that the Green Mountain Care Board would act as arbiter if parties disagreed about relevance. "We prefer that there be no objections, but we still leave out the possibility that... there's an opportunity to object," Charlie said, explaining that current practice often resolves disputes informally between attorneys.

Committee members pressed on standards of review. Several speakers debated terminology: "relevant," "reasonable," and "directly related to the filing" were discussed as possible statutory language. Board and carrier attorneys told the committee that "relevant to the filing and to the review criteria" would help preserve the advocate's ability to ask about non‑actuarial statutory review factors — affordability, access to care and quality — which the advocate said can require qualitative inquiry beyond actuarial spreadsheets.

Panelists described the current operational timeline: insurers said they often have two weeks to respond to questions routed through the board and that tighter or broader questioning could strain already compressed internal timelines and external consulting resources. MVP noted it serves roughly 30,000 members in Vermont's small group and individual markets and said responses often require cross‑functional input from actuarial, legal and operations teams.

No formal vote or regulatory change was adopted during the session. Committee members asked the parties to submit suggested statutory language; staff indicated it would collect draft language for the committee to consider.

The discussion highlighted a tradeoff legislative drafters must weigh: protecting the advocate's ability to develop on‑record evidence about affordability, access and quality while limiting burdens on carriers and the board that can be reflected in premium costs. The committee asked for suggested language and signaled it would consider proposals that preserve non‑actuarial review criteria while adding procedural limits or timelines.