Requires insurance companies to prove that a healthcare service or procedure is not medically necessary.

## Summary of the Bill

This bill would change the way disputes over medical coverage are handled between insurance companies and patients in Rhode Island. Currently, when an insurance company denies a healthcare service or procedure by claiming it isn't medically necessary, the patient often bears the burden of proving that the service *is* needed. This bill would flip that responsibility, requiring the insurance company to prove that a service or procedure is *not* medically necessary before denying coverage.

In practical terms, this means that if a doctor recommends a treatment and the insurance company wants to deny it, the insurer would need to provide evidence supporting its decision that the treatment isn't needed, rather than putting the patient in the position of fighting to justify the care their doctor has recommended. This shifts the burden of proof from the patient to the insurance company in coverage disputes related to medical necessity.

The bill would affect Rhode Island residents who have health insurance, as well as the insurance companies operating in the state. Patients could benefit from fewer denied claims or a stronger position when appealing denials, since insurers would need to justify their decisions more thoroughly. Insurance companies would face a higher standard when deciding to reject coverage for services that healthcare providers have deemed necessary. The bill has been introduced in the Rhode Island House of Representatives and referred to the House Health & Human Services Committee for consideration.