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HB 2619

Insurance Companies, Agents, Brokers, Policies - As introduced, establishes the Tennessee commission of insurance review; prohibits a health insurance entity from offering or maintaining a health benefit plan that uses downcoding in a manner that prevents the provider from collecting the fee for actual services performed either from the health benefit plan or the patient; makes other changes related to health insurance and health insurers. - Amends TCA Title 4; Title 8; Title 56 and Title 71.

114th Regular Session (2025-2026) Introduced by Dan Howell

Tennessee bill prohibits health insurers from downcoding services to block provider payment collection, establishes insurance review commission to oversee compliance.

Taken off notice for cal in s/c Finance, Ways, and Means Subcommittee of Finance, Ways, and Means Committee
#agents #brokers #insurancecompanies #policies
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Bill Summary · HB 2619

Legislative bill overview

HB 2619 creates a Tennessee Commission of Insurance Review and prohibits health insurers from using "downcoding" practices that prevent providers from collecting full payment for services rendered—either from the insurance plan or from patients. The bill modifies multiple sections of Tennessee code governing insurance regulation, health benefits, and related matters.

Why is this important

Downcoding occurs when insurers reimburse providers at lower rates than billed (e.g., coding a service at a lower complexity level), potentially leaving providers unable to recover actual service costs. This bill directly addresses healthcare provider revenue and could affect insurance premiums, provider participation in plans, and patient access to care—making it relevant to both healthcare consumers and the provider community.

Potential points of contention

  • Provider vs. insurer interests: Insurers may argue downcoding helps control costs and premiums, while providers contend it shifts losses onto them; the bill takes a clear provider-protection stance that could increase insurer costs
  • Patient cost implications: Stricter reimbursement rules could increase insurance premiums or reduce plan options available to consumers
  • Commission structure and authority: The new Insurance Review Commission's composition, funding, and enforcement powers are not detailed in the summary, raising questions about regulatory burden and effectiveness

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

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