Grievance: means a written appeal of an adverse determination or final adverse determination submitted by or on behalf of a covered person regarding:
Availability, delivery or quality of healthcare services regarding an adverse determination. See Tennessee Code 56-61-102
Health carrier: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits or healthcare services. See Tennessee Code 56-61-102
This chapter shall be known and may be cited as the “Tennessee Health CarrierGrievance and External Review Procedure Act.”
The purpose of this chapter is to provide standards for the establishment and maintenance of procedures by health carriers to assure that covered persons and healthcare providers have the opportunity for the appropriate resolution of grievances, as defined in this chapter.