Who should I call if I have any questions about filing a complaint?

You can contact the Tennessee Department of Commerce and Insurance at (615) 741-2241. The Department is open from 8:00 a.m. to 4:30 p.m., Monday through Friday.

What happens after the Division receives my complaint?

The Division will forward a copy of your complaint to your health insurer, who has two weeks to respond. The Division will review the insurer’s response. If the Division determines that your insurer violated your insurance policy, the Division will...

How do I file a complaint?

If you are a Tennessee resident and your insurer still denies your claim after the external review process, you can file a complaint with the Tennessee Department of Commerce and Insurance, Division of Insurance (“Division”). Complaint information. Your complaint should include...

How long will the external review process take?

The external review process should take no more than 40 days after the external review organization receives your request.[22] If you requested an expedited external review, the process should take no longer than 72 hours after your request is received by...

How do I request an external review?

You should submit your request for an external review to your health insurer within six months from when your insurer sent you its final decision.[17] Your health insurer must provide you with instructions on how to submit your request.[18] You should submit...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[12] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Tennessee law, you are entitled to request an external...

How long should the internal appeals process take?

The first level appeal should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or treatment but are waiting for...

How do I request a second level appeal?

If your insurer denies your claim after the first level internal appeal, you can request a second level of internal appeals.[5] This second level internal appeal is entirely optional.[6] Your health insurer is required to provide you with notice and instruction...

How do I request a first level appeal?

If your insurer denies your claim, you have the right to an internal appeal.[1] This means you can ask your insurer to conduct a full and fair review of its decision. Your insurer may offer two levels of internal appeals. The...

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