Patient Refunds for Bad Denials Act of 2026

This bill establishes penalties for health insurance companies that deny a high percentage of patient claims, aiming to protect consumers from frequent rejections. Under the new rules, the government could fine insurers up to $10 million plus additional amounts for every percentage point their denial rate exceeds 25 percent, provided the denials are not based on proven fraud or lack of medical necessity. If a company pays these fines, the money is distributed proportionally among the patients enrolled in that insurer's plans during the year. The legislation also requires insurers to explain why they denied claims as medically unnecessary and to report their overall denial rates to the government annually. These measures take effect for plan years starting on or after January 1, 2027.