{"data":{"id":"us-ky/krs-304.17a-716","jurisdiction":"us-ky","citation":"KRS 304.17A-716","heading":"Prohibition against denial or reduction of payment for covered health","body":"benefit -- Conditions.\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 covered\nunder the covered person's health benefit plan if:\n(a) The covered person's provider, during normal business hours, contacts the\ninsurer or the insurer's designee or agent on the day the covered person is\nexpected to be discharged to re quest review of the covered person's continued\nhospitalization and the insurer, designee, or agent fails to provide a utilization\nreview decision within twenty -four (24) hours of the request and prior to the\ntime upon which any previous authorization will expire; or\n(b) 1. The covered person's provider makes at least three (3) documented\nattempts during a four (4) consecutive hour period to contact the insurer,\ndesignee, or agent during normal business hours to request:\na. Review of a continued hospital stay;\nb. Preauthorization of treatment for a covered person who is already\nhospitalized; or\nc. Retrospective review of an emergency hospital admission where\nthe covered person remains hospitalized at the time the review\nrequested is made; and\n2. The insurer, designee, or private review agent fails to be accessible via a\ntoll-free telephone line for forty (40) hours per week during normal\nbusiness hours.\n(2) The insurer's liability to pay for the covered person's hospitalization under the\ncircumstances set fort h in subsection (1) of this section shall extend until the\ninsurer, designee, or private review agent issues a utilization review decision on a\nrequest for review of the matters addressed under subsection (1)(b) of this 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 failure 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, shall\nbe made by the means required by the insurer, designee, or agent for requesting\nutilization review.\n(5) This section applies only when the request for review concer ns 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 does not furnish the information requested by the insure r 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=29337","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:48Z","sha256":"2fd42ccd392fea723dfd62e0ba8fde27c0c7e78a73dc589a9cb71f7755179ec4","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-714","next":"us-ky/krs-304.17a-718"},"notice":"GroundRules: Original legal text. Not legal advice."}