{"data":{"id":"us-ky/krs-304.32-147","jurisdiction":"us-ky","citation":"KRS 304.32-147","heading":"Requirements for health service corporation that issues policy or","body":"administers program providing for utilization review of benefits.\n(1) Every nonprofit hospital, medical -surgical, dental, and health service corporation\nproposing to issue or deliver  in this state a health insurance policy or contract or\nadminister a health benefit program which provides for the coverage of hospital\nbenefits and the utilization review of those benefits by a private review agent shall:\n(a) Be a registered private revie w agent in accordance with KRS 304.17A -607\nand administrative regulations promulgated under the authority of KRS\n304.17A-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, a nonprofit\nhospital, medical-surgical, dental, and healt h service corporation shall not deny or\nreduce payment of health benefits to any person, licensed practitioner, or health\nfacility for covered services which have been rendered to an insured unless:\n(a) Notice of denial has been issued. The notice shall in form patients, authorized\npersons, and health -care providers of their right to appeal adverse\ndeterminations of a utilization review by the insurer, its designee, or private\nreview agent to the insurer for the internal appeal 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 appeal to the cabinet; and\n(b) The nonprofit hospital, medical -surgical, dental, and health service\ncorporation is in compliance with subsection (1) of this section.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=29776","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:54Z","sha256":"fecde04194de9e3be204754666762d7219149ffcc4faf8633fb3f68a404a53fc","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.32-145","next":"us-ky/krs-304.32-150"},"notice":"GroundRules: Original legal text. Not legal advice."}