{"data":{"id":"us-ky/krs-304.17a-615","jurisdiction":"us-ky","citation":"KRS 304.17A-615","heading":"Prohibition against denying or reducing payments under certain","body":"circumstances.\n(1) No insurer or any other person providing or administering a health benefit plan shall\ndeny or reduce payment for a service, procedure, treatment, drug or device cove red\nunder the covered person's health benefit plan if:\n(a) The covered person's provider, during normal business hours, contacts the\ninsurer, the designee, or agent on the day the covered person is expected to be\ndischarged, in order to request review of t he covered person's continued\nhospitalization, and the insurer, designee, or agent fails to provide a timely\nutilization review decision as required by KRS 304.17A-607; or\n(b) The covered person's provider makes at least three (3) documented attempts\nduring a four (4) consecutive hour period to contact the insurer, designee, or\nagent, during normal business hours in order to request review of a continued\nhospital stay, preauthorization of treatment for a covered person who is\nalready hospitalized, or retros pective review of an emergency hospital\nadmission where the covered person remains hospitalized at the time the\nreview requested is made, and the insurer, designee, or private review agent\nfails to be accessible as required by KRS 304.17A-607.\n(2) The insu rer's liability to pay for the covered person's hospitalization under the\ncircumstances set forth in subsection (1) of this section shall extend until the\ninsurer, designee, or private review agent issues a utilization review decision\napplicable to requests for review relating to matters as set forth in subsection 1(b) of\nthis section.\n(3) The insurer's liability to pay under this section shall be conditioned on:\n(a) The provider establishing verifiable documentation of the contact with, and\nsubsequent fail ure of the insurer, designee, or agent to make the utilization\nreview decision as set forth in subsection (1)(a) of this section; or\n(b) The provider establishing verifiable documentation of the attempt to make\ncontact with the insurer, designee, or agent as addressed in subsection (1)(b)\nof this section.\n(4) In either instance, the contact, or attempts to contact, as set forth in this section,\nshall be made by the means required by the insurer, designee, or agent for\nrequesting utilization review.\n(5) This section applies only when the request for review concerns covered health\nbenefits and it shall not supersede any limitations or exclusions in the covered\nperson's health benefit plan. This section shall not apply if, in requesting a review,\nthe provider d oes not furnish the information requested by the insurer or agent to\nmake a utilization review decision, or if actions by the provider impede an insurer's\nor private review agent's ability to issue a utilization review decision.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17457","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"4fdfaed1a585c4edf95f5f08869d0ab03fbb2bb3d1b0eff5dac3a760106b2982","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-613","next":"us-ky/krs-304.17a-617"},"notice":"GroundRules: Original legal text. Not legal advice."}