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SB 234 (BR 2342) - L. Casebier, J. Denton, D. Karem
AN ACT relating to insurance.
Amend KRS 304.39-020 to eliminate the presumption that medical bills submitted to a no-fault motor vehicle insurer are reasonable; amend KRS 304.39-210 to require a provider of medical expenses to submit a statement of medical expenses incurred to a reparation obligor within 45 days of the date treatment is initiated and every 45 days thereafter; provide that failure to timely submit a statement of medical expenses will render the expenses not compensable; prohibit a provider from billing a patient for services which have been denied by a reparation obligor for failure to submit bills within 45 days following treatment; amend KRS 304.19-270 to permit a reparation obligor to require a person to submit to a mental or physical examination at the expense of the reparation obligor; delete the requirement that the reparation obligor petition a court for an order directing such examination; permit a reparation obligor to limit coverages for persons who fail to submit to an examination pursuant to contract provisions approved by the commissioner of the Department of Insurance; authorize a reparation obligor to submit any claim for benefits to an independent review, evaluation, or opinion to determine issues such as reasonable medical necessity, appropriateness of treatment, whether charges are usual and customary, and whether the injury or loss is related to the accident.
SB 234 - AMENDMENTS
SCS - Amend KRS 304.39-020 to provide under the definition of "medical expense" when a medical bill shall not be presumed reasonable; define "emergency care"; amend KRS 304.39-210 to require medical expense benefits for providers of emergency care to be paid by the reparation obligor directly to persons supplying products, services, or accommodations to the claimant; provide that basic reparations benefits be paid without regard to fault and be primary except for benefits payable under a workers' compensation law; require a provider of services for medical expenses, other than medical expenses billed by a hospital or other provider for emergency care or inpatient services rendered at a hospital, to submit claims to a reparation obligor within 45 days from the date the services are provided; amend KRS 304.39-241 to provide exception for emergency care services where the reparation obligor pays the provider directly; amend KRS 304.39-270 to permit a reparation obligor to require a person to submit to a mental or physical examination by a health care provider licensed in Kentucky; require the reparation obligor to pay for the costs of the examination; create new sections of Subtitle 39 of KRS Chapter 304 to permit a reparation obligor to submit a claim for an independent review of reparation benefits to determine if the medical expenses furnished to a reparation insured are medically necessary or reasonable; permit a reparation obligor to contract with a private review agent to perform independent reviews of medical expenses; restrict disclosure of medical records or other confidential medical information; require written notice of decisions to the reparation insureds and providers; define "adverse determination"; require every reparation obligor to have an appeals process to be utilized by the reparation obligor; permit the appeals process to be initiated by the reparation insured or a provider acting on the insured's behalf.
SFA (1, L. Casebier) - Delete the definition of "emergency care" and create a definition of "emergency medical expense"; provide that the reparation obligor may require a mental or physical examination after an independent review of the insured's medical condition has been conducted; require persons providing or performing independent reviews use the services of physicians or other appropriate health care providers.
SFA (2, L. Casebier) - Delete the definition of "emergency care" and create a definition of "emergency medical expense"; provide that the reparation obligor may require a mental or physical examination after an independent review of the insured's medical condition has been conducted; require persons providing or performing independent reviews use the services of physicians or other appropriate health care providers; replace Sections 5 and 6 with new sections to provide that a reparation obligor may submit a claim for an independent review of reparation benefits to determine whether medical expenses furnished to a reparation insured are medically necessary or reasonable; require every reparation obligor have an appeal process to be used by reparation insureds or providers of health care services.
Feb 24-introduced in Senate
Feb 27-to Banking and Insurance (S)
Mar 10-reported favorably, 1st reading, to Calendar with Committee Substitute
Mar 11-2nd reading, to Rules
Mar 16-floor amendment (1) filed to Committee Substitute
Mar 17-floor amendment (2) filed to Committee Substitute
Mar 18-recommitted to Appropriations and Revenue (S)
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