Section 230-RICR-20-30-4.12 - Price DisclosureA. The purpose of this § 4.12 of this Part is to empower consumers who are enrollees in a health insurance plan to make cost effective decisions concerning their health care, and to enable providers to make cost-effective treatment decisions on behalf of their patients who are enrollees of a health insurance plan, including referral and care coordination decisions.B. A health insurer shall not enforce a provision in any participating provider agreement which purports to obligate the health insurer or health care provider to keep confidential price information requested by a health care provider for the purpose of making cost-effective clinical referrals, and for the purpose of making other care coordination or treatment decisions on behalf of their patients who are enrollees in the health benefit plan of the health insurer.C. At the request of a health care provider acting on behalf of an enrollee-patient, a health insurer shall disclose in a timely manner to the health care provider such price information as the provider determines is necessary to make cost-effective treatment decisions on behalf of their patients, including clinical referrals, care coordination, and other treatment decisions.D. A health insurer may adopt reasonable policies and procedures designed to limit the disclosure of price information for unauthorized purposes.230 R.I. Code R. 230-RICR-20-30-4.12
Amended effective 12/4/2018
Amended effective 6/25/2020
Amended effective 8/20/2023