TennCare Appeal Letter Template

Tip: use your browser's Print or "Save as PDF" option to download this. 🖨️ Print Now

TennCare Appeal Letter Template

From caidee.org · Tennessee TennCare resource

Fill in the bracketed sections with your information. You have 30 days from the date on your denial notice. Send certified mail.

[Your Name]
[Your Address]
[Your City, TN ZIP]
[Date]

TennCare Appeals
P.O. Box 593
Nashville, TN 37202

Re: Appeal of Denial Decision
Member Name: [Beneficiary's full name]
Case/Member ID: [From denial notice]
Date of Denial Notice: [Date on denial letter]

To Whom It May Concern:

I am writing to appeal the denial of [Katie Beckett / nursing home coverage / CHOICES / specific service] for [beneficiary name], dated [denial notice date]. I respectfully disagree with this decision based on the following:

Reason 1 — Specifics: The denial cited [exact reason from denial letter, e.g., "does not meet institutional level of care"]. However, the enclosed [physician letter / medical records / daily care log] documents that [specific facts: "my child requires 24-hour skilled nursing care for ventilator management, with suctioning every 3 hours and G-tube feeds every 4 hours"].

Reason 2 (if applicable): [Additional reasons — e.g., "documentation was submitted but not considered in original review"]

Enclosed for your review:

  1. Letter from Dr. [Name], treating [specialty], dated [date]
  2. Updated medical records from [hospital/clinic] covering [date range]
  3. Daily care log for [date range]
  4. [IEP / SSI determination / other supporting documents]

Based on the enclosed evidence, I request that TennCare reverse this decision and approve [requested coverage].

I am also requesting [select what applies]:

  • A fair hearing if the reconsideration does not result in approval
  • Continued benefits during the appeal period (if this is a termination, not initial denial)
  • An expedited review based on [medical emergency rationale]

Please confirm receipt of this appeal in writing within 10 days. You can reach me at [phone] or [email].

Sincerely,

____________________________
[Your signature]
[Your name printed]
[Date]

Sending Instructions

Make a copy of everything for your records
Send via Certified Mail with Return Receipt
Save the tracking number and signed receipt
Call TennCare Connect (1-855-259-0701) 10 days later to confirm receipt
If you don't receive acknowledgment in 15 days, call again

caidee.org/downloads/appeal-template · Updated for 2026 TennCare rules · Not legal advice — for navigation guidance only