{"data":{"id":"us-ky/krs-304.17a-540","jurisdiction":"us-ky","citation":"KRS 304.17A-540","heading":"Disclosure of limitations on coverage -- Denial letter.","body":"(1) Any insurer that limits coverage for any treatment, procedure, a drug, or device\nshall define the limitations and fully disclose those limits in the health insurance\npolicy or certificate coverage.\n(2) (a) Any insurer that denies coverage for a treatment, procedure, a drug that\nrequires prior approval, or device for an enrollee shall provide the enrollee\nwith a denial letter that shall include:\n1. The state of licensure and title of the person making the decision;\n2. A statement setting forth the specific medical and scientific reasons for\ndenying coverage of a service, if the coverage is denied for reasons of\nmedical necessity; and\n3. Instructions for initiating or complying with the plan's grievance or\nappeal procedure stating at a minimum whether the appeal must be in\nwriting, any time limitations or schedules for filing appeals and the\nname and phone number of a contact person who can provide additional\ninformation.\n(b) The denial letter shall be provided within:\n1. Two (2) regular working days of the submitted request where\npreauthorization for a treatment, procedure, drug, or device is involved;\n2. Twenty-four (24) hours of the submitted request where hospital\npreadmission review is sought;\n3. Twenty (20) working days of the receipt of requested medical\ninformation where the plan has initiated a retrospective review; and\n4. Twenty (20) working days of the initiation of the review  process in all\nother instances.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=56516","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"c236f7ac5706c48d482f49504000291dae594b30fc41b94a106a7349b7bad653","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-535","next":"us-ky/krs-304.17a-545"},"notice":"GroundRules: Original legal text. Not legal advice."}