2009 Kentucky Revised Statutes Subtitle 17A. Health Benefit Plans 304.17A.641 Treatment of a stabilized covered person with an emergency medical condition in a nonparticipating hospital's emergency room.
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304.17A-641 Treatment of a stabilized covered person with an emergency medical
condition in a nonparticipating hospital's emergency room.
(1) Where a covered person with an emergency medical condition has been stabilized,
as required by the Consolidated Omnibus Budget Reconciliation Act of 1985 <br>(COBRA), 42 U.S.C. sec. 300bb, in the emergency department of a nonparticipating <br>hospital, and an insurer under its health benefit plan requires prior authorization for <br>poststabilization treatment, approval or denial under the preauthorization <br>requirement shall be provided in a timely manner appropriate to conditions of the <br>patient and delivery of the services, but in no case to exceed two (2) hours from the <br>time the request is made and all relevant information is provided. The insurer's <br>failure to make a determination within the two (2) hour time frame, shall constitute <br>an authorization for the hospital to provide the medical service for which prior <br>authorization was sought.
(2) The nonparticipating hospital providing emergency room services, poststabilization
treatment, or both, shall be paid at a rate negotiated between the nonparticipating <br>hospital and the insurer. Nothing in this section is to be construed as requiring the <br>payment of one hundred percent (100%) of the billed charges.
Effective: July 14, 2000 <br>History: Created 2000 Ky. Acts ch. 262, sec. 20, effective July 14, 2000.
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