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Kentucky Revised Statutes Title XXV. Business and Financial Institutions § 304.17A-611.Prohibition against retrospective denial of coverage for health care services under certain circumstances; prohibition against prospective or concurrent review of prescription drug for alcohol or opioid use disorder

Current as of January 01, 2025 | Updated by Findlaw Staff

(1) 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.

(2) An insurer of a health benefit plan shall not require or conduct a prospective or concurrent review for a prescription drug:

(a) That:

1. Is used in the treatment of alcohol or opioid use disorder; and

2. Contains Methadone, Buprenorphine, an opioid antagonist, or Naltrexone; or

(b) That was approved before January 1, 2022, by the United States Food and Drug Administration for the mitigation of opioid withdrawal symptoms.

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Cite this article: FindLaw.com - Kentucky Revised Statutes Title XXV. Business and Financial Institutions § 304.17A-611.Prohibition against retrospective denial of coverage for health care services under certain circumstances; prohibition against prospective or concurrent review of prescription drug for alcohol or opioid use disorder - last updated January 01, 2025 | https://codes.findlaw.com/ky/title-xxv-business-and-financial-institutions/ky-rev-st-sect-304-17a-611/

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