2016 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 17 - Health Insurance Contracts 304.17-412 Requirements for insurer that issues policy or administers program providing for utilization review of benefits.
Download as PDF
304.17-412 Requirements for insurer that issues policy or administers program
providing for utilization review of benefits.
(1)
(2)
Every health insurer proposing to issue or deliver in this state a health insurance
policy or contract or administer a health benefit program which provides for the
coverage of hospital benefits and the utilization review of those benefits by an
insurer, its designee, or a private review agent shall:
(a) Be registered in accordance with KRS 304.17A-607 and administrative
regulations promulgated under the authority of KRS 304.17A-613; or
(b) Contract with a private review agent that has been registered in accordance
with KRS 304.17A-607 and administrative regulations promulgated under the
authority of KRS 304.17A-613.
Notwithstanding any other provision of KRS 304.17A-603, 304.17A-605, 304.17A607, 304.17A-609, 304.17A-611, 304.17A-613, and 304.17A-615, an insurer or its
designee shall not deny or reduce payment of health benefits to any person, licensed
practitioner, or health facility for covered services which have been rendered to an
insured unless:
(a) Notice of denial has been issued. The notice shall inform patients, authorized
persons, and health-care providers of their right to appeal adverse
determinations of a utilization review by the insurer, its designee, or private
review agent to the insurer for the internal review process established by the
insurer in accordance with KRS 304.17A-617 and 304.17A-619. The notice
shall also include instructions on filing an internal appeal; and
(b) The insurer is in compliance with subsection (1) of this section.
Effective: July 14, 2000
History: Amended 2000 Ky. Acts ch. 262, sec. 26, effective July 14, 2000. -- Amended
1998 Ky. Acts ch. 426, sec. 523, effective July 15, 1998. -- Amended 1996 Ky. Acts
ch. 353, sec. 1, effective July 15, 1996. -- Created 1990 Ky. Acts ch. 451, sec. 7,
effective July 13, 1990.
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.