Use this form ONLY to appeal. DO NOT use it to apply for TennCare.
Tiene problemas para obtener atención médica en TennCare? En Español (pdf, 1,395kb)
Important APPEAL information.
Step 1. Print this form (pdf, 59kb) .
Step 2. Fill it out.
Step 3. Make a copy of the completed form to keep for your records.
Step 4. Mail to
PO Box 593, Nashville, TN 37202-0593
OR FAX (toll-free) 1-888-345-5575
Keep a copy of the page that shows your fax went through.
Kurdish, Arabic, Somali, Bosnian or Vietnamese (pdf, 193kb)
QUESTIONS: Telephone (toll-free) 1-800-878-3192 TTY/TDD: 1-866-771-7043
Have your services been denied, delayed, reduced, suspended, or terminated?
Call your health plan first. Their free phone number is on your TennCare card.
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.
You have the right to appeal if:
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.
Usually, your appeal is decided within 90 days after you file it. 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).
An emergency means if you don't get the care sooner than 90 days:
If you think you have an emergency, you can ask TennCare for an emergency appeal. Your appeal may go faster if your doctor signs your appeal saying that it is an emergency. What if your doctor doesn't sign your appeal, but you ask for an emergency appeal? TennCare will ask your doctor if your appeal is an emergency. If your doctor says it's not an emergency, TennCare will decide your appeal within 90 days.
Have questions? Need help? Want to appeal?
Call TennCare Solutions for free at 1-800-878-3192.
We do not allow unfair treatment in TennCare. No one is treated differently because of race, color, birthplace, religion, language, sex, age, or disability. Do you think you've been treated unfairly? Then call the Family Assistance Service Center for free at 1-866-311-4287.
View this document in a printable pdf (pdf, 56kb).