State RegulationsTN specificDifficulty 1/5
Under Tennessee law, which statutory provisions govern external review of a health carrier's adverse grievance determinations?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
External review in Tennessee is governed by the Tennessee Health Carrier Grievance and External Review Procedure Act, with T.C.A. § 56-61-113 and 56-61-116 as the cited external-review provisions. These sections give enrollees a state-law mechanism for independent review of a health carrier's adverse determinations, under the oversight of the Tennessee Department of Commerce & Insurance.
Why the other options are wrong
- A) T.C.A. § 56-6-113 and 56-6-116 concern producer compensation and fiduciary duties, not health carrier external review.
- B) T.C.A. § 56-42-107 and 56-42-111 belong to the Long-Term Care Insurance Act, covering contestability and penalties for long-term care products.
- D) T.C.A. § 56-7-1002 and 56-7-1003 are mandated-coverage provisions, not external review provisions.
Memory hook
External review lives in the grievance and external review act.