New to helping someone in Tennessee?
You do not need a law degree to help someone fight a health insurance denial. Start by gathering three basic documents:
- Insurance card — shows which company administers the plan. Use the name and phone number on the card when you call or file paperwork.
- Denial letter or explanation of benefits (EOB) — the notice that says a service was denied, not paid, or needs approval first. Look for appeal instructions and a deadline.
- Summary of Benefits and Coverage (SBC) — helps you tell whether the fight is about medical necessity or whether the benefit exists at all.
Your first tasks: identify what type of plan this is (HealthCare.gov, job-based, Medicaid, Medicare) and write down the appeal deadline from the letter.
For most regulated commercial plans, Tennessee law gives you an internal appeal with the insurer first, then a right to external review through an independent review organization (IRO) assigned by your health carrier under the Health Carrier Grievance and External Review Procedure Act (Ch. 56-61).
For steps that work in every state, read these general guides first, then return here for Tennessee rules:
What is different in Tennessee?
- HealthCare.gov: Tennessee uses the federal Marketplace at HealthCare.gov. Major 2026 carriers include BlueCross BlueShield of Tennessee, Ambetter (Celtic), Cigna, Oscar, UnitedHealthcare, and Alliant Health Plans (availability varies by county).
- Prior authorization: Prior Authorization Fairness Act (§§ 56-7-3701–3722, effective January 1, 2025) — 7 calendar days deemed approved for non-urgent PA, 72 hours (+1 business day when applicable) for urgent; 17-day overall cap on the PA process.
- Internal appeals: Ch. 56-61 — first-level decision within 30/60 days; optional second level; 72-hour urgent appeals.
- External review: File with your health carrier within six months of the final denial (§ 56-61-114); IRO decision within 40 days standard / 72 hours expedited; binding on the plan.
- Medicaid (TennCare): Medical benefit appeals through TennCare Member Medical Appeals (60 days from when you learn of the problem)—not commercial IRO review. Eligibility appeals use a separate 40-day fair-hearing window.
Who is in charge of your plan?
- TDCI (Tennessee Department of Commerce & Insurance): Regulates most fully insured commercial health plans — tn.gov/commerce/insurance. Consumer Insurance Services: 800-342-4029 · 615-741-2218 · CIS.Complaints@tn.gov
- U.S. Department of Labor: Many self-funded employer plans.
- TennCare: Medical appeals — How to file a medical appeal · 800-878-3192 · Eligibility appeals — How to file an eligibility appeal · TennCare Connect 855-259-0701
- CMS: Medicare and Medicare Advantage.
After appeals are exhausted, see Regulator complaints.