What is the average health insurance denial rate in Tennessee?

Health insurers in Tennessee deny approximately 22.9% of ACA marketplace claims, which is 3.8 points above the national average of 19.1%.

How do I appeal a denied insurance claim in Tennessee?

File a written internal appeal with your insurer within 180 days of the denial. If denied again, escalate to an Independent Medical Review (IMR) with the Tennessee Department of Commerce & Insurance. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in Tennessee?

Based on CMS Marketplace Transparency data, the insurers with the highest denial rates in Tennessee are Oscar Health, Cigna Healthcare, Ambetter from Centene. See each insurer's full denial report for category-level breakdowns.

What are my rights if my insurance claim is denied in Tennessee?

You have the right to a full written explanation of the denial, an internal appeal, and an external Independent Medical Review with the Tennessee Department of Commerce & Insurance. Federal law requires insurers to respond to standard appeals within 30 days and urgent appeals within 72 hours.

Tennessee Insurance Denial Report

The worst health insurers in Tennessee
by claim denial rate

Tennessee averages a 22.9% denial rate — 3.8 points above the national average. About 380,000 claims are denied annually.

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22.9%

Tennessee avg denial rate

19.1%

National average

380,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in Tennessee

In Tennessee, the health insurance claim denial rate stands at a concerning 22.9%, significantly higher than the national average of 19.1%. This translates to approximately 380,000 claims denied each year, affecting countless individuals and families who rely on health insurance for essential medical services. Such a high denial rate highlights the challenges many patients face when seeking coverage for necessary treatments and procedures. Understanding this landscape is crucial for Tennesseans as they navigate their healthcare options and advocate for their rights.

Fortunately, patients in Tennessee have the right to appeal denied claims. The Tennessee Department of Commerce & Insurance oversees these matters, ensuring that individuals can escalate their cases if they believe their claims were unjustly denied. By exercising their right to appeal, patients can take proactive steps to challenge denials and potentially secure the coverage they deserve. It is essential for individuals to be informed about their rights and the processes available to them, empowering them to advocate for their healthcare needs effectively.

Worst insurers in Tennessee by denial rate

Source: CMS Marketplace Transparency Report 2023. In-network ACA marketplace claims only.

Oscar Health

34.6% denial rate

Oscar denies 34.6% of claims — 15.5 points above the national average. Their appeal overturn rate is 58%.

GLP-1 Medications: 46% deniedMental Health: 41% deniedSpecialty Medications: 38% denied

Full Oscar denial report →

Cigna Healthcare

33.1% denial rate

Cigna denies 33.1% of claims — 14.0 points above the national average. Their appeal overturn rate is 61%.

GLP-1 Medications: 44% deniedSpecialty Medications: 40% deniedMental Health: 37% denied

Full Cigna denial report →

Ambetter from Centene

21.3% denial rate

Ambetter denies 21.3% of claims — 2.2 points above the national average. Their appeal overturn rate is 53%.

GLP-1 Medications: 36% deniedSpecialty Medications: 28% deniedMental Health: 24% denied

Full Ambetter denial report →

Your rights as a Tennessee insurance patient

Tennessee law provides specific protections for patients facing insurance claim denials. Individuals have the right to an internal appeal, allowing them to contest a denial directly with their insurer. If the outcome is still unfavorable, patients can request an external Independent Medical Review, offering an unbiased assessment of their claim. The Tennessee Department of Commerce & Insurance serves as the regulatory body overseeing these processes. Additionally, filing a complaint with this department is free of charge and can exert pressure on insurers to reconsider their decisions, further empowering patients in their fight for fair treatment.

Tennessee Department of Commerce & Insurance
https://www.tn.gov/commerce/insurance

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How to appeal a denial in Tennessee

1
Request the denial in writing
Ask your insurer for the specific clinical criteria and coverage policy they used to deny you. They are legally required to provide it within 30 days.
2
File your internal appeal
Send a written appeal to your insurer within 180 days. Cite your doctor's clinical documentation, relevant medical guidelines, and Tennessee insurance law. A well-written appeal citing specific laws wins over 80% of the time.
3
Escalate to the state if denied again
If your internal appeal is denied, file an Independent Medical Review (IMR) with the Tennessee Department of Commerce & Insurance. This is free and decided by independent clinicians. Their decision is often binding.
4
Use disputes.health to generate your letter
Our agents generate a clinic-grade appeal letter in under 15 minutes — citing your state's laws, relevant medical guidelines, and your specific situation. We then submit it to your insurer for you.

How to appeal a denial →GLP-1 denial guide →Mental health denial guide →All public resources →

Denied in Tennessee? Fight back today.

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The worst health insurers in Tennesseeby claim denial rate