{"data":{"id":"us-ky/krs-304.17a-619","jurisdiction":"us-ky","citation":"KRS 304.17A-619","heading":"Duty of covered person, authorized person, or provider to provide","body":"insurer with new information regarding internal appeal -- Time frame for\ninsurer to render a decision based on new information -- Insurer's failure to\nmake timely determination or provide written notice.\n(1) (a) If the covered person, authorized person, or provider has new clinical\ninformation regarding the covered person's internal appeal, he or she shall\nprovide that information to the insurer prior to the initiation of th e external\nreview process.\n(b) The insurer shall have five (5) business days from the date of the receipt of\nthe information to render a decision based on the new information.\n(c) If new information is provided in accordance with this subsection, the sixty\n(60) day time frame for commencing an external review as set forth in KRS\n304.17A-623(4), shall not begin to run, until the insurer or its designee\nrenders a decision regarding the new information.\n(2) The insurer's failure to make a determination or prov ide a written notice within the\ntime frames set forth in KRS 304.17A-617 shall be deemed to be an adverse benefit\ndetermination, other than a coverage denial, by the insurer for the purpose of\ninitiating an external review as set forth in KRS 304.17A-623.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=57344","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"e9a2fce67125fdd0032cab4553546093d10f97a93be2485355bcf36018a93415","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-617","next":"us-ky/krs-304.17a-621"},"notice":"GroundRules: Original legal text. Not legal advice."}