Patient Refunds for Bad Denials Act of 2026

Summary

The Patient Refunds for Bad Denials Act of 2026 would let the Health Secretary levy civil monetary penalties on health insurers whose claim denial rate reaches 25% or more. Penalties are capped at $10 million plus $2 million for each percentage point above the threshold, and the collected funds must be distributed pro‑rata to the plan’s members. The bill also forces insurers to explain medical‑necessity denials and to report their overall denial percentages each year.

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