External review in Tennessee: deadline, cost and how to ask
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.
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.
Step 2: Outside review in Tennessee
- Program
External Review
- Who runs it
- External review organization (ERO) approved by the Tennessee Department of Commerce and Insurance: Insured health plans and HMOs regulated by TDCI
- Deadline to ask
6 months
You can file a written request for external review with your health carrier within 6 months after you receive the denial notice.
- The deadline runs from
The date you receive the notice of the adverse determination or final adverse determination
- Do I have to appeal to my plan first?
You must usually finish the carrier's grievance process first. You count as having finished it if the carrier has not decided your grievance within 30 days (care not yet received) or 60 days (care already received), unless you agreed to a delay, or if the carrier agrees to waive it. In urgent cases you can ask for expedited external review at the same time as an expedited internal review. Claims for care already received must go through the internal process first.
- When you can go without a plan answer
30 days after you file your internal appeal
- How long the review takes
Standard: 40 days
- Cost
The health carrier pays the cost of the external review organization.
- What can be reviewed
Adverse determinations based on medical necessity, appropriateness, health care setting, level of care or effectiveness, and denials of experimental or investigational treatment. There is no state review when the service is simply not a covered benefit under the plan.
- Is the decision final?
The decision is binding on the carrier, on you and on your provider, except for other remedies under federal or state law. You cannot ask for a second external review of the same denial.
- How to ask
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. You can send more information in writing to the external review organization within 6 business days after the notice that your review was accepted. A standard review is decided within 40 days of the request.
- Phone
Write my appeal: free letters
Sources
The official sources for Tennessee are listed on the Tennessee page.