Prohibits payers from requiring uncompensated referral coordination by primary care providers, require either elimination of referral prior authorizations, and prevent denial of lab coverage based solely on diagnostic coding differences.

Rhode Island Primary Care Administrative Fairness Act

This bill targets the administrative burden placed on primary care doctors by health insurance companies. Currently, insurance plans often require doctors to coordinate patient referrals to specialists — a time-consuming process — without paying them for that work. This bill would prohibit insurers from requiring primary care providers to perform that unpaid coordination work. It would also push insurers to either eliminate or significantly reduce the "prior authorization" requirement for referrals, which is the process where a doctor must get insurance company approval before sending a patient to a specialist.

The bill also addresses a specific problem with laboratory test coverage. Sometimes insurance companies deny payment for lab work not because the test itself was inappropriate, but because of technical differences in the billing codes used to describe a diagnosis. This bill would prevent insurers from rejecting lab coverage for that reason alone, meaning patients would be less likely to face unexpected bills for routine bloodwork or other tests simply due to a coding technicality.

The people most directly affected are primary care physicians and their office staff, who currently spend significant time and resources managing insurance paperwork without compensation. Patients would also benefit, since reducing prior authorization hurdles could mean faster access to specialist care, and fewer surprise bills for lab tests. Health insurance companies operating in Rhode Island would need to update their policies and processes to comply with these new rules if the bill becomes law.

The bill has been introduced and referred to the House Health & Human Services Committee, where it will be reviewed before any further action is taken.