Disclosure of limitations on coverage -- Denial letter
KRS 304.17A-540
in effect304.17A-540. Disclosure of limitations on coverage -- Denial letter
(1) Any insurer that limits coverage for any treatment, procedure, a drug, or device shall define the limitations and fully disclose those limits in the health insurance policy 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 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: June 27, 2025
History: Amended 2025 Ky. Acts ch. 146, sec. 2, effective June 27, 2025. -- Amended 2000 Ky. Acts ch. 500, sec. 6, effective July 14, 2000. -- Created 1998 Ky. Acts ch. 496, sec. 33, effective April 10, 1998.
Source: Kentucky Legislative Research Commission (legislature.ky.gov)URL: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=56516Fetched: 10/20/2026