{"data":{"id":"us-ky/krs-304.17-412","jurisdiction":"us-ky","citation":"KRS 304.17-412","heading":"Requirements for insurer that issues policy or administers program","body":"providing for utilization review of benefits.\n(1) Every health insurer proposing to issue or deliver in this state a health insurance\npolicy or contract or administer a health benef it program which provides for the\ncoverage of hospital benefits and the utilization review of those benefits by an\ninsurer, its designee, or a private review agent shall:\n(a) Be registered in accordance with KRS 304.17A -607 and administrative\nregulations promulgated under the authority of KRS 304.17A-613; or\n(b) Contract with a private review agent that has been registered in accordance\nwith KRS 304.17A-607 and administrative regulations promulgated under the\nauthority of KRS 304.17A-613.\n(2) Notwithstanding any other provision of KRS 304.17A-603, 304.17A-605, 304.17A-\n607, 304.17A-609, 304.17A-611, 304.17A-613, and 304.17A -615, an insurer or its\ndesignee shall not deny or reduce payment of health benefits to any person, licensed\npractitioner, or health facil ity for covered services which have been rendered to an\ninsured unless:\n(a) Notice of denial has been issued. The notice shall inform patients, authorized\npersons, and health -care providers of their right to appeal adverse\ndeterminations of a utilization r eview by the insurer, its designee, or private\nreview agent to the insurer for the internal review process established by the\ninsurer in accordance with KRS 304.17A -617 and 304.17A -619. The notice\nshall also include instructions on filing an internal appeal; and\n(b) The insurer is in compliance with subsection (1) of this section.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17344","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"665b3f8411646bca783ed7871cc243a664350a4405c19ca918eb9362d645b623","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17-410","next":"us-ky/krs-304.17-415"},"notice":"GroundRules: Original legal text. Not legal advice."}