What If I Am Having Trouble Getting Services?
Call your health plan first. Their free phone number is on your TennCare card. See a list of health plan contact numbers.
Don’t have your card? Or, still have problems after you call your health plan? Then, call TennCare Solutions for free at 1-800-878-3192. They can help you with your problem or help you file an appeal. An appeal is one way to fix problems with TennCare.
What are the reasons for a Medical Appeal?
- TennCare says NO when you ask for health care.
- Or, TennCare stops or changes your health care.
- Or, you have to wait too long to get health care.
- Or, you have health care bills you think TennCare should have paid for, but didn’t.
- Or, there’s some other reason you can’t get health care when you need it.
When Filing A Medical Appeal Won’t Help
- You don’t have any other way to pay for the health care or medicine TennCare won’t cover.
- You or your doctor thinks the care or medicine is medically necessary, but TennCare won’t cover that care or medicine.
- You think there should be an exception made to the rules in your case
How Long Do I have to file a medical appeal?
You only have 30 days to appeal after you find out that there is a problem. You can ask someone to help you file an appeal.
After you file a medical appeal, your appeal is usually decided within 90 days. What if you can’t wait 90 days for your health care or medicine? If you have an emergency, your appeal can be decided sooner—usually within 31 days (but sometimes up to 45 days). To learn more about emergency appeals, visit the medical appeals page on TennCare's website. Scroll down to the bottom of the first page to section #4.
How do I file a Medical Appeal?
1. You can appeal by phone
Call the TennCare Solutions Unit at 1-800-878-3192. It’s a free call. Write down and keep the date and time you called and the name of the person you talked to.
2. Or, you can appeal by mail
- Or, you can write your appeal on plain paper. Be sure to include:
- Your Full name
- Your Social Security Number
- The names of anyone in the household with the same problem
- Daytime phone number and best time to call
- The mistake you think TennCare made
- Proof that shows why you think TennCare made a mistake
Make a copy of your appeal to keep for your records.
Mail your Medical Appeal to:
PO Box 593
Nashville, TN 37202-0593
Or Fax your Medical Appeal (toll-free) to 1-888-345-5575
Keep a copy of the page that shows your fax went through.
Do you have questions or need help filing a medical appeal? Call the TennCare Advocacy Program at 1-800-758-1638.