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Understanding Your Rights

We value our members. As a TennCare or CoverKids member, we want you to know your rights and get the care you need. Here are a few things you should know.

If you have any questions, contact us. And if you want to learn more about protecting yourself against unfair treatment based on race, religion or other characteristics, see our Civil Rights Notice.

  • BlueCare and TennCareSelect
  • CoverKids
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BlueCare and TennCareSelect  

If you're having problems with your BlueCare or TennCareSelect plan, we want to hear from you. You can contact us.

You also have the right to file an appeal. When you appeal, you ask a judge to decide if BlueCare or TennCareSelect made a mistake. You have 60 days to appeal once you think there’s a problem.

There are two kinds of appeals:

Administrative Appeals are for problems like:

  • Getting or keeping TennCareSM
  • Disagreeing with the kind of TennCare you have
  • If you think your income or co-pay amounts are wrong
Medical Appeals are for health care services that have been denied, reduced, terminated or delayed.

How do I file an Administrative Appeal?

There are two ways that you or someone who has the legal right to act for you can file an appeal.

  • Appeal by phone by calling TennCare Connect free at 1-855-259-07011-855-259-0701.
  • Write your appeal on plain paper and mail to:
    TennCare Connect
    Eligibility Appeals Unit
    P.O. Box 23650
    Nashville, TN 37202-3650

You have 60 days to appeal after you find out that there is a problem.

How do I file a Medical Appeal?

Medical Appeals are for health care services that have been denied, reduced, terminated or delayed.

BlueCare and TennCareSelect member medical appeals are handled by the TennCare Solutions Unit. There are several ways that you or someone who has the legal right to act for you can file an appeal.

Fax to: 1-888-345-​5575

Mail to:
TennCare Solutions
P.O. Box 000593
Nashville, TN 37202-0593

What information do I need to provide when I file an appeal?

When you file an appeal over the phone or in writing, you’ll need to include:

  • Your full name (first name, middle initial, last name)
  • Your Social Security Number
  • The names of other people who live with you with the same problem
  • Your daytime phone number and the best time to call
  • The specific mistake you think was made. Tell as much about the problem as you can
  • Copies of any papers that show why you think the mistake was made

Keep a copy of your appeal. Write down the date that you mailed it to TennCare.

More information about appeals can be found in Part 6 and Part 7 of your BlueCare or TennCareSelect handbook.

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CoverKids  

If you're having problems with your CoverKids plan, we want to hear from you. You can contact us.

As a CoverKids member, you have the right to file an appeal or a grievance. When you appeal, you ask a judge to decide if CoverKids made a mistake. A grievance is an official complaint.

There are two different kinds of appeals. Here’s how they’re different from a grievance:

Administrative Appeals are for problems like:

  • Getting or keeping CoverKids
  • Disagreeing with the kind of CoverKids you have
  • If you think your income or co-pay amounts are wrong
Medical Appeals are for health care services that have been denied, reduced, terminated or delayed.

Grievances are when you call or send a letter to tell us you are not happy about a decision that CoverKids made. These would not be for a denial, reduction, delay or termination of services.

You have 60 days to appeal once you think there’s a problem.

How do I file an Administrative Appeal?

There are two ways that you or someone who has the legal right to act for you can file an appeal.

  • Appeal by phone by calling TennCare Connect free at 1-855-259-07011-855-259-0701.
  • Write your appeal on plain paper and mail to:
    TennCare Connect
    Eligibility Appeals Unit
    P.O. Box 23650
    Nashville, TN 37202-3650

You have 60 days to appeal after you find out that there is a problem.

How do I file a Medical Appeal?

Medical Appeals are for health care services that have been denied, reduced, terminated or delayed.

There are two ways that you or someone who has the legal right to act for you can file an appeal.

  • Call us at 1-888-325-83861-888-325-8386, Monday through Friday, 8 a.m. to 6 p.m., ET.  TTY: 1-866-591-29081-866-591-2908
  • Write your appeal on plain paper or print and fill out the appeal form

Mail to:
BlueCross BlueShield of Tennessee
Commercial Member Grievance
1 Cameron Hill Circle, Suite 0019
Chattanooga, TN 37401-0019

What information do I need to provide when I file an appeal?

When you file an appeal over the phone or in writing, you’ll need to include:

  • Your full name (first name, middle initial, last name)
  • Your Social Security Number
  • The names of other people who live with you with the same problem
  • Your daytime phone number and the best time to call
  • The specific mistake you think was made. Tell as much about the problem as you can
  • Send copies of any papers that show why you think the mistake was made

Keep a copy of your appeal. Write down the date that you mailed it to TennCare.

More information about appeals can be found in Part 6 and Part 7 of your CoverKids handbook.

What are examples of a Member Grievance with CoverKids?

A Grievance is not a complaint about a denial, reduction, delay or termination of services. (That would be an appeal.)

Some examples of grievances include:

  • The quality of care or services received
  • Access to healthcare providers
  • Provider care
  • Treatment or administrative issues
How do I file a Member Grievance with CoverKids?

There are two ways that you or someone who has the legal right to act for you can file a member grievance.

  • Call us at 1-888-325-83861-888-325-8386, Monday through Friday, 8 a.m. to 6 p.m. ET. TTY: 1-866-591-29081-866-591-2908
  • Write your grievance on plain paper and mail to:

    • BlueCross BlueShield of Tennessee
    Commercial Member Grievance
    1 Cameron Hill Circle, Suite 0019
    Chattanooga, TN 37401-0019

What information do I need to provide when I file a Member Grievance with CoverKids?

When you file a grievance over the phone or in writing, you’ll need to include:

  • Your name (the name of the person who wants to file a grievance about their care)
  • Member number. If you don’t have the Member number, give your date of birth. Include the month, day and year
  • The address where you get your mail
  • The name of the person to call if CoverKids has a question about your grievance (this can be you or someone else)
  • A daytime phone number for that person (this can be your phone number or another person’s phone number)

More information about Member Grievances can be found in Part 6 and Part 7 of your CoverKids handbook.