We have denied your request for the provision of or payment for a healthcare service or course of treatment. You have the right to have our decision reviewed by healthcare professionals who have no association with us if our decision involved making a judgment as to the medical necessity, appropriateness, healthcare setting, level of care or effectiveness of the healthcare service or treatment you requested by submitting a written request for external review to us.
Structure 2021 Tennessee Code
Chapter 61 - Tennessee Health Carrier Grievance and External Review Procedure Act
§ 56-61-102. Chapter Definitions
§ 56-61-104. No Limitations or Restrictions on Denying Coverage of Services Not Medically Necessary
§ 56-61-110. Rules and Regulations
§ 56-61-111. Penalties for Violations
§ 56-61-113. Notice of Right to External Review
§ 56-61-122. Hold Harmless for External Review Organizations