First Level Grievances - General Information. A. In deciding a first level grievance of an adverse benefit determination that is based in whole or in part on a medical judgment, including determinations with regard to whether a particular treatment, drug, or other item is experimental, investigational, or not medically necessary or appropriate, or based in whole or in part on any other adverse benefit determination that is an appealable decision pursuant to Vermont’s independent external review laws, the reviewers shall include at least one (1) clinical peer of the Enrollee's treating provider.
