Prohibits health insurance companies or other payors from including in physician participation agreements any provisions that restrict or prevent a physician from charging patients reasonable administrative or operational fees to support overhead.

Plain-English Summary

This bill, called the Primary Care Preservation Act, would limit what health insurance companies can require of doctors when they sign contracts to participate in an insurance network. Specifically, it would prevent insurance companies from including contract terms that stop doctors from charging patients small additional fees to help cover the everyday costs of running a medical practice — things like office rent, staff salaries, medical supplies, and other overhead expenses.

Currently, insurance contracts often include rules that restrict what doctors can charge patients beyond what the insurance company pays. This bill would make those kinds of restrictions illegal in Rhode Island, as long as the fees a doctor charges are considered "reasonable" and are meant to cover administrative or operational costs. In other words, doctors would have more freedom to add modest fees on top of insurance reimbursements to help keep their practices financially sustainable.

This bill primarily affects primary care doctors and other physicians who participate in insurance networks, as well as their patients. Doctors could potentially benefit from additional revenue to offset rising practice costs. However, patients could be affected by new out-of-pocket fees they don't currently pay, even if they have insurance coverage. Insurance companies and other health plan administrators would also be affected, as they would lose the ability to prohibit these fees through their contracts with doctors.

The bill has been introduced in the Rhode Island House of Representatives and was referred to the House Health & Human Services Committee before being transferred to the House Corporations Committee for further review.