Kentucky Revised Statutes Title XXV. Business and Financial Institutions § 304.17A-716.Prohibition against denial or reduction of payment for covered health benefit; conditions

(a) The covered person's provider, during normal business hours, contacts the insurer or the insurer's designee or agent on the day the covered person is expected to be discharged to request review of the covered person's continued hospitalization and the insurer, designee, or agent fails to provide a utilization review decision within twenty-four (24) hours of the request and prior to the time upon which any previous authorization will expire; or

(b) 1. The covered person's provider makes at least three (3) documented attempts during a four (4) consecutive hour period to contact the insurer, designee, or agent during normal business hours to request:

a. Review of a continued hospital stay;

b. Preauthorization of treatment for a covered person who is already hospitalized; or

c. Retrospective review of an emergency hospital admission where the covered person remains hospitalized at the time the review requested is made; and

2. The insurer, designee, or private review agent fails to be accessible via a toll-free telephone line for forty (40) hours per week during normal business hours.

(a) The provider establishing verifiable documentation of the contact with, and subsequent failure of the insurer, designee, or agent to make the utilization review decision as set forth in subsection (1)(a) of this section; or

(b) The provider establishing verifiable documentation of the attempt to make contact with the insurer, designee, or agent as addressed in subsection (1)(b) of this section.