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SB 2468

AN ACT RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION REVIEW ACT

2026 Regular Session Introduced by Jonathon Acosta and 9 co-sponsors

SB 2468 revises Rhode Island's insurance utilization review requirements to alter how insurers approve or deny coverage for medical treatments and communicate those decisions.

04/16/2026 Committee recommended measure be held for further study
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Bill Summary · SB 2468

Legislative bill overview

SB 2468 modifies Rhode Island's insurance utilization review process—the system insurers use to determine whether to approve coverage for medical treatments. The bill appears to establish or revise requirements for how insurance companies evaluate medical necessity and communicate benefit determination decisions to patients and providers.

Why is this important

Utilization review directly affects patients' access to care by determining what treatments insurers will pay for. Changes to these processes can impact approval timelines, appeal procedures, and whether people can obtain prescribed treatments without delay. This is particularly significant for urgent or ongoing medical needs where denial or delays can have serious health consequences.

Potential points of contention

  • Insurance company compliance costs — Stricter requirements may increase administrative burden and expenses that could be passed to consumers through higher premiums
  • Speed of approvals vs. scrutiny — Balancing faster benefit determinations against thorough medical necessity reviews; faster approvals might reduce quality control
  • Appeal and override procedures — Disagreement over how easily patients/providers can challenge denials and who has final authority on contested medical decisions
  • Definition of "medical necessity" — Questions about whether the bill adequately defines standards or leaves room for inconsistent insurer interpretations

Compiled from official sources — confirm details with the bill’s official record.

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