Health insurance or Medicaid said no in Tennessee? Deadlines and free help

In Tennessee, your health plan is regulated by Tennessee Department of Commerce and Insurance (TDCI), Insurance Division, Consumer Insurance Services, if it is a state-regulated plan.

Tennessee runs its own independent review of denials: External Review. You generally have 6 months to ask for it.

External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

Medicaid / TennCare (and CoverKids)

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (HealthCare.gov) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

Checked against official sources: October 30, 2026.

Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.

Some of Tennessee's rules rest on limited sources.

Check the official sources below, or ask a legal aid office, before you rely on them.

How long do I have in Tennessee?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
6 months
Hearing deadline
40 days
Appeal to the plan first
60 days (federal rule)
Appeal deadline – HealthCare.gov
90 days (federal rule)

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

If you bought insurance yourself or have insurance from an employer that does business only in Tennessee, contact the Tennessee Department of Commerce and Insurance. If your coverage is through a self-insured employer (typically a large company or one with locations in several states), contact the U.S. Department of Labor, EBSA.

Step 1: Appeal to your plan in Tennessee

What it is called: Grievance (first level review, with an optional second level review)

Your health carrier must decide a first level review within 30 days for care you have not received yet (prospective review) and within 60 days for care already received (retrospective review). An expedited review must be decided within 72 hours. Carriers also offer a second level review where you can appear before a review panel.

Law: Tenn. Code Ann. 56-61-107 to 56-61-109 (enacted as Pub. Ch. 980 of 2010, §§ 8-10)

All the details →

Step 2: Outside review in Tennessee

External Review

Deadline to ask: 6 months.

All the details →

Urgent care in Tennessee: faster decisions

Outside review

You can ask for expedited external review if waiting for the standard timeline would seriously jeopardize your life, health or ability to regain maximum function, or if the denial concerns emergency care and you have not been discharged. The reviewer decides within 72 hours.

Standard: 40 days

Medicaid

If waiting 90 days could put your life or physical or mental health in real danger, call 1-800-878-3192 to ask for an expedited medical appeal. Your doctor can ask for you with your written OK and can fill out the Treating Provider's Certificate: Expedited TennCare Appeal form. If granted, a decision comes in about one week (longer if your health plan needs more time to get your medical records).

Complaints about your plan in Tennessee

For other problems with your insurer, file a complaint with the Department of Commerce and Insurance, Consumer Insurance Services (1-800-342-4029 or 615-741-2218).

www.tn.gov

Medicaid (TennCare (and CoverKids)) denials in Tennessee

Who holds the hearing: TennCare (Eligibility Appeals Unit / Member Medical Appeals); hearings before an administrative judge.

Hearing deadline: 40 days

All the details →

Marketplace decisions in Tennessee

Tennessee uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.

HealthCare.gov

1-855-231-1751

Other rights in Tennessee

TennCare medical appeals go to TennCare

For a TennCare service problem (care denied, cut, stopped, delayed, or unpaid bills), you file one medical appeal with TennCare Member Medical Appeals by phone, online, mail or fax, and can ask on the form to keep your care during the appeal.

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Tennessee and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Tennessee

Good to know in Tennessee

  • Tennessee's external review law gives 6 months after the denial notice to request external review, longer than the federal minimum of 4 months.

    Law: Tenn. Code Ann. 56-61-116(a), enacted as Pub. Ch. 980 of 2010, § 17

  • TennCare eligibility appeals have a 40-day filing window, and coverage continues if you appeal within 20 days of the notice or before your coverage ends.
  • TennCare medical appeals are filed directly with TennCare, which offers a toll-free line that can take the appeal by phone (TennCare, How to File a Medical Appeal).
  • Tennessee external review organizations must decide standard reviews within 40 days of the request, shorter than the federal 45 days.

    Law: Pub. Ch. 106 of 2013, amending Tenn. Code Ann. 56-61-116(m)

Questions about appeals in Tennessee

How long do I have to appeal a health insurance denial in Tennessee?

You have 180 days after you receive the denial notice to file a grievance with your health carrier. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.

How do I get an outside (external) review in Tennessee?

External Review. Send a written request for external review to your health carrier (the address and forms come with the final denial). The carrier checks eligibility within 10 business days and tells you within 3 business days after that; if it says your request is not eligible, you can appeal that to the Commissioner of Commerce and Insurance.

Is outside review free in Tennessee?

The health carrier pays the cost of the external review organization.

How long do I have to ask for a Medicaid fair hearing in Tennessee?

40 days. The date of the termination or denial notice (eligibility appeals)

Can I keep my Medicaid benefits while I appeal in Tennessee?

Eligibility appeals: your TennCare continues if you appeal within 20 days of the notice, or before your coverage end date if that is later. Medical (service) appeals: ongoing care can continue if you appeal within 10 days of the date of the notice or before the date of the change, whichever is later, and ask to keep the care.

Who regulates health insurance in Tennessee?

Tennessee Department of Commerce and Insurance (TDCI), Insurance Division, Consumer Insurance Services. If you bought insurance yourself or have insurance from an employer that does business only in Tennessee, contact the Tennessee Department of Commerce and Insurance. If your coverage is through a self-insured employer (typically a large company or one with locations in several states), contact the U.S. Department of Labor, EBSA.

Not about a denied claim?

Nearby states

Sources

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