There is a newer version of the Kentucky Revised Statutes
2009 Kentucky Revised Statutes
Subtitle 17A. Health Benefit Plans
304.17A.615 Prohibition against denying or reducing payments under certain circumstances.
Download pdfunder the covered person's health benefit plan if:
(a) The covered person's provider, during normal business hours, contacts the insurer, the designee, or agent on the day the covered person is expected to be
discharged, in order to request review of the covered person's continued
hospitalization, and the insurer, designee, or agent fails to provide a timely
utilization review decision as required by KRS 304.17A-607; or (b) The covered person's provider makes at least three (3) documented attempts during a four (4) consecutive hour period to contact the insurer, designee, or
agent, during normal business hours in order to request review of a continued
hospital stay, preauthorization of treatment for a covered person who is
already hospitalized, or retrospective review of an emergency hospital
admission where the covered person remains hospitalized at the time the
review requested is made, and the insurer, designee, or private review agent
fails to be accessible as required by KRS 304.17A-607. (2) The insurer's liability to pay for the covered person's hospitalization under the circumstances set forth in subsection (1) of this section shall extend until the
insurer, designee, or private review agent issues a utilization review decision
applicable to requests for review relating to matters as set forth in subsection 1(b) of
this section. (3) The insurer's liability to pay under this section shall be conditioned on: (a) The provider establishing verifiable documentation of the contact with, and subsequent failure of the insurer, designee, or agent to make the utilization
review decision as set forth in subsection (1)(a) of this section; or (b) The provider establishing verifiable documentation of the attempt to make contact with the insurer, designee, or agent as addressed in subsection (1)(b)
of this section. (4) In either instance, the contact, or attempts to contact, as set forth in this section, shall be made by the means required by the insurer, designee, or agent for
requesting utilization review. (5) This section applies only when the request for review concerns covered health benefits and it shall not supersede any limitations or exclusions in the covered
person's health benefit plan. This section shall not apply if, in requesting a review,
the provider does not furnish the information requested by the insurer or agent to
make a utilization review decision, or if actions by the provider impede an insurer's
or private review agent's ability to issue a utilization review decision. Effective: July 14, 2000
History: Created 2000 Ky. Acts ch. 262, sec. 8, effective July 14, 2000.
Disclaimer: These codes may not be the most recent version. Kentucky may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.