Rhode Island Department of Health Genetics Website

Health Insurance & Legislation

Genetic Discrimination and Rhode Island Policy

Health insurance coverage for genetic services varies depending on who your provider is and what plan you enrolled in. Currently, there is no federal legislation to protect the public against genetic discrimination by insurance providers. States have varying genetic discrimination laws. Rhode Island’s legislature has passed several bills addressing genetics and/or health insurance.

Be sure to read your Explanation of Benefits (EOB) form to see what services will be covered. Some insurance companies will preapprove genetic services. You can also challenge your insurance company's judgment in deciding what services they will cover. Utilization review (UR) is a measure that allows insurance companies not to pay for services that they decide are not medically necessary. A test or service that your insurance company deems unnecessary may be necessary for your individual situation. You can also appeal the amount of money your insurer reimburses you. Keep copies of all your medical bills and other records! You will need to contact your individual insurer for specific information on their appeals process.

If your claim is denied after the appeals process, contact the appropriate government agency:

• For Medicare, contact your local Social Security office
• For private insurance, contact Health Services Regulation at (401) 222-6015 at the RI Department of Health