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Health Care Claims Disputes: Statutes - Kentucky

A collection of statutes, treatises and cases dealing with disputes under various federal and state medical insurance plans.

Health Insurance Claim Disputes

806 KAR 12:092. Unfair life and health insurance claims settlement practices

Kentucky Insurance Statutes

Kentucky's Insurance Statutes begin at Title XXV. Business and Financial Institutions, Chapter 304. Insurance Code, Subtitle 17. Health Insurance Contracts, KY ST T. XXV, Ch. 304, Subt. 17, Refs & Annos. (KRS 304.17)
 
Group and Blanket Health Plans are defined at Title XXV. Business and Financial Institutions, Chapter 304. Insurance Code, Subtitle 18 (KRS 304.18).

Kentucky Medicaid Statute and Regulations

Kentucky's Medicaid Program is authorized in Title XVII. Economic Security and Public Welfare, Chapter 205. Public Assistance and Medical Assistance (Refs & Annos), Medical Assistance (State Medicaid Program) at KRS § 205.510 et seq. Ky. Rev. Stat. Ann. § 205.510 (West).

 

And, Kentucky's Medicaid Program is implemented by Title 907. Cabinet for Health and Family Services Department for MedicaidServices, Chapter 1. Medicaid Services at 907 Ky. Admin. Regs. 1:675.

Is Kentucky's Any Willing Provider Preempted by ERISA?

SCt37:12 Brief of Amicus Curiae—ERISA
 
QUESTION PRESENTED

Whether Kentucky’s “any willing provider” law, which requires each health maintenance organization (HMO) in the State to make available to its subscribers the services of any medical provider in its geographical region that agrees to the terms and conditions offered by the HMO, is saved from preemption as a law that “regulates insurance” under ERISA Section 514(b)(2)(A), 29 U.S.C. 1144(b)(2)(A).

STATEMENT - Kentucky’s “any willing provider” law (“AWP”) provides: A health insurer shall not discriminate against any provider who is located within the geographic coverage area of the health benefit plan and who is willing to meet the terms and conditions for participation established by the health insurer, including the Kentucky state Medicaid program and Medicaid partnerships.
 
DISCUSSION
A. Any Willing Provider Laws “Relate to” ERISA Plans
B. AWP Laws Are Saved By ERISA’s Insurance Saving Clause
 
CONCLUSION - The Court should hold the petition for a writ of certiorari in this case pending its decision in Rush Prudential HMO, Inc. v. Moran, No. 00-1021, cert. granted (June 29, 2001), and then dispose of it accordingly.

Secondary Sources of Interest

See 87 A.L.R.3d 429 for a full discussion of situations where attorney's fees have been awarded and denied.  However, in KY, there are no particular statutory provisions for awarding attorneys fees.  Thus, it is up to the court to consider "bad faith" performance.

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