What does Preamble of Patient Refunds for Bad Denials Act of 2026 do?

This bill proposes to amend title XXVII of the Public Health Service Act. The proposed amendment aims to establish civil liability for health insurance issuers. The liability is specifically linked to health insurance issuers with high levels of claims denials.

What does SHORT TITLE. of Patient Refunds for Bad Denials Act of 2026 do?

This bill is formally titled the Patient Refunds for Bad Denials Act of 2026.

What does ESTABLISHING CIVIL LIABILITY FOR HEALTH INSURANCE ISSUERS WITH of Patient Refunds for Bad Denials Act of 2026 do?

This section amends the Public Health Service Act to establish civil liability for health insurance issuers with high claims denial rates. The Secretary may impose a civil monetary penalty on issuers offering group or individual health insurance coverage if the claims denial percentage exceeds 25 percent (or a lower percentage specified by the Secretary). The 'claims denial percentage' is determined through audits and excludes claims correctly denied due to fraud or lack of medical necessity. The penalty amount is initially $10,000,000, plus an additional $2,000,000 for each percentage point the denial rate exceeds 25 percent. Collected penalty amounts will be distributed pro rata to individuals enrolled in coverage from issuers subject to the penalty. Health insurance issuers must provide a notice to individuals whose claims are denied on the basis of medical necessity, including the issuer's medical necessity standards and an explanation of why the service failed to meet those standards. Issuers must also submit to the Secretary the percentage of claims denied for any reason for each plan year.

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Patient Refunds for Bad Denials Act of 2026

Last updated: 4/22/2026 · Introduced: 4/22/2026

Author: Angie Craig (D-MN)

TL;DR (AI)

This bill establishes civil monetary penalties for health insurance issuers with claims denial rates exceeding 25 percent, with penalties escalating based on the extent of the excess.
Penalty funds collected from insurers will be distributed to individuals who were enrolled in coverage from those penalized insurers.
Health insurance issuers are required to notify individuals of denied claims based on medical necessity and submit annual claims denial percentage reports to the Secretary.

119th Congressin committeeOfficial page

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Includes provisions on preamble, short title., and 1 more.

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