There is a newer version of the Kentucky Revised Statutes
2009 Kentucky Revised Statutes
Subtitle 17A. Health Benefit Plans
304.17A.540 Disclosure of limitations on coverage -- Denial letter.
Download pdfpolicy or certificate coverage. (2) (a) Any insurer that denies coverage for a treatment, procedure, a drug that requires prior approval, or device for an enrollee shall provide the enrollee
with a denial letter that shall include:
1. The name, license number, state of licensure, and title of the person
making the decision; 2. A statement setting forth the specific medical and scientific reasons for
denying coverage of a service, if the coverage is denied for reasons of
medical necessity; and 3. Instructions for initiating or complying with the plan's grievance or
appeal procedure stating at a minimum whether the appeal must be in
writing, any time limitations or schedules for filing appeals and the
name and phone number of a contact person who can provide additional
information. (b) The denial letter shall be provided within: 1. Two (2) regular working days of the submitted request where
preauthorization for a treatment, procedure, drug, or device is involved; 2. Twenty-four (24) hours of the submitted request where hospital
preadmission review is sought; 3. Twenty (20) working days of the receipt of requested medical
information where the plan has initiated a retrospective review; and 4. Twenty (20) working days of the initiation of the review process in all
other instances. Effective: July 14, 2000
History: Amended 2000 Ky. Acts ch. 500, sec. 6, effective July 14, 2000. -- Created 1998 Ky. Acts ch. 496, sec. 33, effective April 10, 1998.
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