State Law

KY. Rev. Statutes-Chapter 304-Subtitle 17A-Health Benefit Plans-Utilization Reviews

08/05/2023 Kentucky Section 304.17A-611

Prohibition against retrospective denial of coverage for health care services under certain circumstances

Retroactive Denial

A utilization review decision shall not retrospectively deny coverage for health care services provided to a covered person when prior approval has been obtained from the insurer or its designee for those services, unless the approval was based upon fraudulent, materially inaccurate, or misrepresented information submitted by the covered person, authorized person, or the provider.