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

What This Bill Does

This bill would change the rules around how health insurance companies can deny coverage for medical treatments or procedures. Currently, when a patient or their doctor requests coverage for a healthcare service, the burden often falls on the patient or provider to prove that the treatment *is* medically necessary. This bill would flip that responsibility — requiring the insurance company to prove that a service or procedure is *not* medically necessary before they can deny coverage for it.

Who It Affects

This bill would affect anyone in Rhode Island who has health insurance and needs medical care approved by their insurer. It would also affect doctors and other healthcare providers who currently spend time and resources fighting insurance denials on behalf of their patients. Insurance companies would face the greatest change, as they would need to provide evidence to justify coverage denials rather than waiting for patients to challenge those decisions.

Where Things Stand

The bill has been introduced in the Rhode Island House and referred to the House Health & Human Services Committee. The committee has recommended holding the bill for further study, meaning it has not yet moved forward in the legislative process. A hearing is scheduled for March 24, 2026, where lawmakers and the public may have the opportunity to weigh in on the proposal.