Request to Insurer for Impartial Appeal. You should send your request for an additional impartial appeal to your insurer if your insurer denied your claim because it deemed your requested treatment or services not medically necessary or experimental/investigational.[8]

The appeal must be made  within four months of receiving your upheld denial letter and you should  send the following documents to the insurer:

  • A written request for an impartial review; and
  • A signed medical records release form, which your insurer should have provided to you with your denial letter.[9]

Your insurer will then send your request to an independent review entity. The insurer will notify you when the external impartial medical review is assigned to the entity.[10]

Request to the Department. If your insurer denied your claim because your plan (1) placed limitations on the requested treatment or services; or (2) did not cover your requested treatment or services, you should submit a request for an impartial review to the Kentucky Department of Insurance, Health and Life Division (“Department”). You should  send the following documents to the Department:

  • A written request for an impartial appeal;
  • A copy of the denial letter from your insurer; and
  • A statement containing the reason you believe coverage should be provided.[11]

You should mail these documents to the following address:

Kentucky Department of Insurance
Health and Life Division
Attn: Coverage Denial Coordinator
P.O. Box 517
Frankfort, KY 40602[12]

The Coverage Denial Coordinator will request information from your insurer and determine whether the service, treatment, drug, or device meets one of the following:

  • Is specifically excluded under your plan and the insurer’s denial was correct;
  • Is covered and will instruct your insurer to pay the claim; or
  • Requires the resolution of a medical issue and will instruct your insurer to either cover the claim or give you the opportunity to request an external review.[13]

Request to Consumer Protection Division for Impartial Review. If your health insurer denied your claim because you failed to follow the requirements or procedures set out in your insurance benefits handbook, or you have a general complaint, you should submit a request for impartial appeal to the Kentucky Department of Insurance, Consumer Protection Division. You can submit your request by completing an online form here or mailing your request to the following address:

Kentucky Department of Insurance
Consumer Protection Division
P.O. Box 517
Frankfort, KY 40602[14]

In your request, you should state your reason for appealing your insurer’s determination and submit any copies of documents that support your position.