Skip to main content
H 8309Health Insurance

Insurance - Fee Schedule Transparency and Fair Billing Act

This bill requires health insurers to publish clear payment rates for doctors and prohibits penalizing doctors for billing those exact rates.

Held for study
Population
Affected
72
Email Legislator
Introduced Mar 18, 2026Committee House Corporations

Plain-English Summary

This legislation mandates that health insurance companies provide participating physicians and medical practices with a complete and current fee schedule. This schedule must list the maximum reimbursement amount for every covered service. The bill requires insurers to pay the full amount of any claim submitted at or below this published maximum rate, prohibiting the requirement for doctors to submit inflated "usual and customary" charges to get paid. It empowers the Office of the Health Insurance Commissioner to enforce these rules with penalties of up to $25,000 per violation and requires annual reporting on disputes.

For younger readers

Imagine you do chores for an allowance, but your parents won't tell you exactly how much each chore is worth until after you do it. Sometimes they might pay you less than you thought. This bill creates a rule for doctors and insurance companies. It says insurance companies must give doctors a list showing exactly how much money the doctors will get paid for their work. If the doctor asks for that amount or less, the insurance company has to pay it fairly without playing any tricks or hiding numbers.

Who & Where It Applies

Impacted groups
PhysiciansHealth Insurance CompaniesMedical PracticesOffice of the Health Insurance CommissionerPatients
Impacted communities
All

Constitutional & Fiscal Check

None Likely

Estimated cost
Amount unknown
Estimated revenue
Amount unknown

Bill Analysis

Both viewpoints
For Progressives
  • Increases transparency in the healthcare system, preventing large insurance corporations from obscuring reimbursement rates to the detriment of providers.
  • Protects smaller medical practices and community clinics from predatory billing practices, potentially helping to keep local healthcare accessible.
  • Establishes strong accountability mechanisms for corporations by empowering a regulatory body to levy significant fines for non-compliance.
  • Focuses primarily on the financial relationship between providers and insurers rather than directly lowering costs or expanding coverage for patients.
  • Relies on the Office of the Health Insurance Commissioner for enforcement, which may require additional public funding or staffing to be effective.
  • Does not mandate higher reimbursement rates for providers in underserved or low-income communities, only transparency regarding existing rates.
For Conservatives
  • Promotes free-market principles by requiring price transparency, allowing businesses (medical practices) to make informed financial decisions.
  • Protects small business owners (private physicians) from being manipulated by large corporate entities with dominant market power.
  • Ensures contractual fairness by preventing insurers from enforcing arbitrary "usual and customary" billing requirements that distort actual market prices.
  • Increases government interference in private business contracts between insurance companies and healthcare providers.
  • Imposes heavy financial penalties ($25,000 per violation) on private companies, which could be viewed as excessive government overreach.
  • Expands the administrative power and oversight scope of a state government agency (Office of the Health Insurance Commissioner).

Votes

Loading votes...

Full Bill Text

Changes to existing Rhode Island law · 28 additions

SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by adding thereto the following chapter: 27-84-1. Short title. This chapter shall be known and may be cited as the “Fee Schedule Transparency and Fair Billing Act.” 27-84-2. Publication of fee schedules.

(a) Every insurer shall publish and provide participating physicians, physician practices, physician corporations, physician partnerships or any other entity providing medical services, with a complete, current fee schedule listing the maximum allowable reimbursement for every covered service and procedure code.

(b) Physicians, physician practices, physician corporations, physician partnerships or any other entity providing medical services shall include, but not be limited to, those healthcare providers in chapters 18, 19, 20 and 41 of title 27.

(c) Updates must be provided within thirty (30) days of any change via secure provider portals. 27-84-3. Fair reimbursement. An insurer shall reimburse any claim submitted at or below the published maximum allowable rate in full, without requiring inflated “usual and customary” charges. No reductions, bundling restrictions, or penalties shall be applied solely based on the charge amount when it does not exceed the published maximum. 27-84-4. Insurer – Definition. For purposes of this chapter, “insurer” means every nonprofit medical service corporation, hospital service corporation, health maintenance organization, or other insurer offering and/or insuring health services; the term shall in addition include any entity defined as an insurer under § 42-62-4. 27-84-5. Enforcement.

(a) The office of the health insurance commissioner shall oversee compliance and may impose penalties of up to twenty-five thousand dollars ($25,000) for each violation of this chapter.

(b) Annual reports on fee schedule availability and billing disputes shall be published by the office of the health insurance commissioner by July 1 of each year.

SECTION 2. This act shall take effect ninety (90) days after passage.