BlueCross BlueShield of Tennessee claim denials in Tennessee: the federal figures
BlueCross BlueShield of Tennessee denied 17.2% of in-network claims in Tennessee — 634,727 claims out of 3,680,920. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to BlueCross BlueShield of Tennessee) | 129 | 42.6% |
| External review (independent) | — | — |
What BlueCross BlueShield of Tennessee denies most
The most common denial reason recorded for BlueCross BlueShield of Tennessee plans in Tennessee is service excluded from the plan. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Service excluded from the plan | 172,216 | 22.2% |
| Other reasons | 149,344 | 19.2% |
| Benefit limit reached | 145,365 | 18.7% |
| Administrative reason | 143,356 | 18.5% |
| Referral required | 90,723 | 11.7% |
| Member not covered | 68,205 | 8.8% |
| Provider out of network | 6,399 | 0.8% |
| Experimental or investigational | 1,188 | 0.2% |
| Not medically necessary | 102 | 0% |
What to do if BlueCross BlueShield of Tennessee denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice. BlueCross BlueShield of Tennessee overturned 42.6% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not BlueCross BlueShield of Tennessee. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your BlueCross BlueShield of Tennessee appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is BlueCross BlueShield of Tennessee's denial rate high?
17.2% against a national average of 16% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can BlueCross BlueShield of Tennessee ignore the external decision?
No. External review decisions are binding on the plan.