Tennessee
Tennessee's credit path depends on your exact carrier and plan.
Tennessee enacted a 2023 direct-payment credit for a qualifying nonemergency covered service from an out-of-network provider when the member-negotiated payment is below the carrier-specific average allowed amount. The statewide law does not cover every Tennessee plan; exact plan scope and carrier documentation still control, and Indiana's forms do not apply.
KnownCost verified the official enacted text, but no counsel-approval receipt is recorded for this guide. Use it only to prepare questions for your insurer; it is not a legal opinion, plan-eligibility determination, or credit decision.
Do not reuse another state's checklist.
- Confirm the exact plan is Tennessee-regulated, fully insured, and not grandfathered. The enacted text expressly excludes TennCare and CoverKids managed-care organizations and grandfathered plans. Medicare and self-funded ERISA plans follow different federal regimes; Tennessee state or local public-employee plans and Farm Bureau products require separate scope verification and must not be assumed eligible.
- Confirm the service is covered and nonemergency and that the provider is out of network. A covered healthcare service can include a prescription drug or device.
- Ask the carrier for the comparable-service average allowed amount through its portal or phone path, and preserve the response. The plan-specific comparison uses carrier allowed amounts from a reasonable window no longer than 30 days; that is not a 30-day response deadline.
- Confirm the negotiated direct-payment amount is strictly below that carrier-and-plan-specific amount. Do not infer the threshold from public cash prices, Medicare, statewide medians, or generic negotiated-rate files.
- Keep the provider order, final bill or statement, provider identity and contact information, negotiated cost, and a statement that you paid out of pocket and the provider is not making a claim against the carrier for the service.
- Electronic transmission is permitted. Confirm the carrier's submission procedure; the enacted text does not set a member-submission deadline.
- If the submission qualifies, the carrier applies the full member-paid amount to deductible, coinsurance, copayment, or other cost sharing for the current contract period. Amounts above the out-of-pocket cap do not carry into the next period.
Use the source this state or plan provides.
No verified public benchmark is available. The required average allowed amount is carrier- and plan-specific, so ask your insurer and keep its response.
Browse verified cash pricesGet the price and service codes in writing.
If you are not using insurance, ask for a written Good Faith Estimate. Federal rules generally require one when you request it or schedule care at least three business days in advance. This price document is separate from the state credit process. Read the CMS guidance →
Read the rule and current instructions.
Educational information only. The plan decides whether a payment qualifies, and state-specific scope, timing, and documentation control.