Patient Refunds for Bad Denials Act of 2026

The Patient Refunds for Bad Denials Act of 2026 would impose civil monetary penalties on health insurance issuers that deny 25% or more of claims for group or individual health coverage in a plan year, with penalties increasing based on how much the denial rate exceeds that threshold. The Secretary of Health and Human Services would conduct audits to determine denial rates, excluding correctly denied claims based on fraud or lack of medical necessity, and would distribute collected penalties pro rata to affected enrollees. The bill also requires insurers to provide detailed explanations when denying claims based on medical necessity and to annually report their overall claims denial rates…

AI summary · The lawmakers haven’t published an official summary of this bill yet, so 52 wrote this one from the bill’s text.