Celtic denied your claim in Tennessee. Here is your deadline.

You are not alone, and here is the measured version of that sentence: 1,099,147 in-network claims were denied by Celtic Insurance Company in Tennessee in a single plan year. A denial rate is a fact about an insurer's book of business. It is not a judgment about you, and it is not the last word on your claim.

• Of the 5 insurers reporting a denial rate in Tennessee, Celtic Insurance Company is the fourth highest at 11.5%. The highest in the state is 23.5% and the lowest is 6%.
• That is 4.2 percentage points below the 15.7% national average across this dataset, and 6 points below the Tennessee average of 17.5%.
• Behind the percentage: 9,568,351 in-network claims were processed under 19 plans in Tennessee, and 1,099,147 of them came back denied.
• For every 10,000 claims Celtic Insurance Company denied, about 30 came back as an internal appeal. The other 9,970 stopped at the letter.
• Of the internal appeals it did receive, Celtic Insurance Company overturned 68.83%, 2,285 claims that started life as a no.
• 23 of those denials went on to independent external review, the stage whose decision the plan is required by law to accept. Nationally 22.2% (1,092 of 4,918; interval 22.2-23.8% for counts CMS withheld; 32.6% without SelectHealth) of external reviews are overturned.
• Its most-recorded denial reason is other reasons at 16.3% of its categorized denials, against 32.4% nationally, a lighter share than the country as a whole. That is the denial mix, not an outcome rate.
• In Tennessee, Celtic Insurance Company reported 11.5%, and the same company files in 5 other states in this file, where the rate is not the same in any of them: 13.5% in Oklahoma, 11.4% in Kansas, 11.3% in Alabama, down to 9.8% in Texas. Which state the plan was bought in moves the odds more than the brand on the card does.
• Celtic Insurance Company accounts for 28.2% of every in-network claim denied in Tennessee in this file.
• By raw volume it is the 18th largest source of denials among the 135 insurer-state records in the file that report one.
• Put another way: one independent external review was filed for every 47,789 claims Celtic Insurance Company denied in Tennessee.
• After that, its second-most-recorded reason is service excluded from the plan, 245,855 claims, 15.8% of its categorized denials.
• Third on its own list is administrative reason, 231,679 claims, 14.8% of what Celtic Insurance Company categorized in Tennessee. Between them the top three account for 46.9% of its categorized denials.
• Where Celtic Insurance Company differs most from the national mix is not medically necessary: 11.3% of its categorized denials in Tennessee against 5.5% across the file.
• Read the other way round: 8,469,204 of those 9,568,351 in-network claims were paid, 88.5% of everything Celtic Insurance Company processed in Tennessee.
• Spread across the 19 plans it reports in Tennessee, that is about 57,850 denied claims per plan, on about 503,597 claims processed per plan.
• Its reason columns add up to 1,560,146 categorized rows against 1,099,147 denials, 141.9% of them, and every reason share on this page is a share of that first figure rather than of the second.
• Its smallest recorded category in Tennessee is benefit limit reached, 124,789 claims, 8% of what Celtic Insurance Company categorized there.
• Against the file as a whole, this one record is 1.3% of the 83,907,852 in-network claim denials reported by every issuer in it.

What happened to appeals

What that record means for your own Celtic Insurance Company letter, and by when. Celtic Insurance Company overturned 68.83% of the 3,320 internal appeals its Tennessee members filed against 1,099,147 denials, and 23 of those Tennessee denials went on to the independent stage whose decision binds the plan, Celtic Insurance Company's own rows in the plan-year 2027 release of the CMS Transparency in Coverage file, read November 4, 2026 (data.healthcare.gov). Whichever way that lands, nobody files the appeal for you, and the filing runs on a clock set by which plan you hold: an employer or Marketplace plan gives you at least 180 days from the denial notice to file the internal appeal (29 CFR 2560.503-1(h)(3)(i), carried onto individual-market coverage by 45 CFR 147.136(b)(3)(i)), while Medicare Advantage gives you 65 calendar days from the date of its notice (CMS, 42 CFR 422.582(b)) and Medicaid managed care 60 calendar days from the date on the notice (42 CFR 438.402(c)(2)(ii)), both stages free, and the three steps above are the whole of what to do tonight, so take the date printed on your Celtic Insurance Company notice and file well inside whichever of those windows is yours. The free steps are above; the $29 kit is the same clock with the letters pre-filled for Celtic Insurance Company in Tennessee. One payment. No subscription. No cut of your claim.

Celtic Insurance Company inside Tennessee

Your denial did not happen in a national average. It happened in a state market, alongside 4 other insurers reporting into the same federal file, and these are that market's own figures.

• Across the whole of Tennessee, the 5 insurers reporting in this file processed 22,206,362 in-network claims and denied 3,896,627 of them, a state denial rate of 17.5%. Celtic Insurance Company is one of those 5.
• That puts Tennessee tenth of 29 states by denial rate, 1.8 points above the 15.7% national average, before you get to what Celtic Insurance Company did inside it.
• Tennessee recorded 30,249 internal appeals against those denials: one appeal for every 129 claims the state's insurers refused. Celtic Insurance Company's own ratio is one for every 331.
• Independent external review was reached 66 times in the whole of Tennessee, once for every 59,040 denials, against one in 17,061 nationally. 23 of those Tennessee filings came from Celtic Insurance Company's denials.
• Of the Tennessee external reviews that were filed, 0 were overturned, 0%. That percentage is measured on 66 reviews, which is why the count beside it matters more than the rate does when you are deciding whether to file against Celtic Insurance Company.
• The reason Tennessee's insurers record most often is administrative reason, 1,458,994 claims, 35.9% of the state's categorized denials. Celtic Insurance Company records other reasons most often instead, which is the argument your letter will need to answer.
• The other insurers a Tennessee reader could have bought from run from 23.5% (BlueCross BlueShield of Tennessee) to 6% (Alliant Health Plans, Inc.). Celtic Insurance Company at 11.5% sits between the two.
• Put the two together and Celtic Insurance Company is responsible for 28.2% of every in-network claim denied in Tennessee in this release, from 43.1% of the claims the state's insurers processed.
• Every Tennessee figure in this section is that state's own row in the same federal file Celtic Insurance Company's numbers above come from, CMS Transparency in Coverage Public Use File (PY2027 release, PY2025 claims), data.healthcare.gov — US Government public domain, and the full Tennessee page is free at /states/tennessee.

What Celtic Insurance Company denies most

The most common denial reason recorded for Celtic Insurance Company plans in Tennessee is other reasons. How that denial is beaten →

The last column is each reason's share of all categorized denials nationally, so you can see where Celtic Insurance Company's mix in Tennessee differs from everyone else's. This is denial mix, not overturn rate by reason, the federal file does not report appeal outcomes broken down by denial reason, and we do not imply otherwise.

The three steps at the top of this page are the whole of what you have to do tonight. The longer version, what the internal appeal has to contain, how the independent stage works, and how to ask for expedited handling when waiting would seriously jeopardize your health, is published free here. For what it is worth on this page specifically: Celtic Insurance Company overturned 68.83% of the internal appeals it received.

Who appeals what at Ambetter (Centene)

Centene's Ambetter runs as state-branded plans (Superior, Sunshine, Peach State and others), the process is published per state. Its sharpest rule: claim-payment disagreements are NOT appeals at all; they go through a separate claim dispute process first. From Ambetter (Centene)'s published pages, written for health care providers (Texas plan page) and members; each is listed below with its date. It is brand-level and applies to Celtic Insurance Company in Tennessee the same as to every other Ambetter (Centene) entity in the file.

Operational facts from the same policy

• Medical-necessity appeal window: 180 calendar days
• Standard resolution clock: 30 calendar days
• Expedited appeal clock: 1 working day / 72 hours from complete information
• Submission (Texas plan): Complaints Department, 5900 E. Ben White Blvd., Austin, TX 78741 · Fax 1-866-683-5369 , Texas plan's address — each state plan publishes its own.
• Member appeal window: 180 calendar days, orally or in writing , Member-side confirmation of the 180-day window; also confirms the 30-day resolution clock ('shall not exceed 30 calendar days from the date Ambetter receives the appeal') and the expedited 1-working-day / 72-hour-written clock.
• Member APPEALS address differs from the complaints address: Appeals Department, 5900 E Ben White Blvd., Austin, TX 78741 · Fax 1-866-918-2266 , Same street address as the Complaints Department but a different fax: appeals go to 1-866-918-2266, grievances/complaints to 1-866-683-5369. The plan page's complaints fax is not the appeals fax.
• External review via MAXIMUS: four months from the final internal decision; standard decided ≤45 days, expedited ≤72 hours , Route: Externalappeal.com, fax 1-888-866-6190, or mail to MAXIMUS Federal Services, 3750 Monroe Avenue, Suite 705, Pittsford, NY 14534. Matches the federal 4-month right this site publishes.

Sources: Ambetter (Centene), "Grievance and Appeals (Ambetter from Superior HealthPlan, Texas)", quoted, not paraphrased; audience: health care providers (Texas plan page); checked 2026-11-05. Ambetter (Centene), "Appeals and Grievances Guide (Ambetter from Superior HealthPlan, Texas — member guide, last updated December 2024)", quoted, not paraphrased; audience: members; checked 2026-11-05. Brand-level policy, applied here because Celtic Insurance Company is an Ambetter (Centene) entity. Your own denial letter and plan documents govern your specific case.

Questions

Everything you need for your Celtic Insurance Company appeal in Tennessee: your two deadlines, the argument that fits your denial reason, the letters, a brief for your doctor on what the reviewer checks, and the external review request. One payment. No subscription. No cut of your claim. Opens on screen the moment you pay. 14-day refund, no questions, one email to hello@getaxionlabs.com.