What is prior authorization?
Prior authorization (PA)—also called preauthorization or included in prospective utilization review—means the health plan must approve certain care before it will cover it. Doctors or hospitals often submit PA for you, but you still have rights if PA is denied.
A PA denial is different from a bill denial after care already happened. With PA, the fight is usually about whether the plan will allow the treatment at all.
Overview for any state: Prior authorizations. This page is Kentucky-only.
Confirm plan type: Kentucky: Start Here.
Kentucky PA & UR rules
Kentucky's utilization review law is in KRS Chapter 304.17A, especially KRS 304.17A-607 (amended by SB 54, effective 2020, with later updates).
Decision deadlines
- Urgent health care services: decision within 24 hours after the insurer has all necessary information (face-to-face evaluation, second opinion if required, and other info the Department of Insurance requires)
- Non-urgent services: decision within 5 days after necessary information is received
If the plan misses deadlines
Failure to decide and give written notice on time is generally deemed prior authorizationfor the service under review—unless the delay is documented as beyond the insurer's control (KRS 304.17A-607(2)).
Who reviews denials
For contracts on or after January 1, 2020, denials for medical necessity or experimental treatment must be made by a Kentucky-licensed physician in the same or similar specialty as the ordering provider when possible.
Published PA lists
Insurers must post utilization review procedures and PA lists on their websites, including effective and expiration dates for PA requirements (SB 54 / 304.17A-603).
Emergency care
Insurers cannot require utilization review before providing emergency health care services (KRS 304.17A-580).
Denial notices must explain appeals
Written denials must include reasons, reviewer credentials, and instructions for internal appeal under KRS 304.17A-617.
Where to look up PA rules
PA is handled by the issuer on the ID card. Common Kentucky Marketplace (kynect) carriers:
- Anthem Blue Cross Blue Shield: anthem.com
- Passport Health Plan / Molina: passporthealthplan.com
- Ambetter / WellCare: ambetterhealth.com
Shop and enroll at kynect.ky.gov · help: 855-459-6328 (855-4kynect).
KanCare (Medicaid)
KanCare MCOs (Humana, UnitedHealthcare Community Plan, Passport by Molina, Aetna Better Health, Wellcare) set PA rules under DMS contracts. Service denials: MCO appeal, then DMS fair hearing—see DMS — MCO options.
If PA is denied
- Get the denial in writing with reasons and appeal instructions.
- Ask the treating clinician for records and a medical-necessity letter.
- File an internal appeal by the deadline — Kentucky internal appeals.
- If still denied, request external review with your insurer within 60 days.
Urgent & emergency care
Use the 24-hour urgent UR rule. Emergency services should not require PA first. For urgent denials, request an expedited internal appeal (3 business days) and, if needed, concurrent expedited external review (Kentucky external review).