Health Claim Denial Transparency Act

Lucy McBath

Democrat · GA · Representative

Source: Congress.gov · FEC

No cosponsors on record. Bills can pass without cosponsors — this often means the sponsor introduced the bill alone, either because it's a messaging bill, a chairman's mark, or simply early in the legislative cycle.

Referred to the House Committee on Education and Workforce.

2026-07-16

Source: Congress.gov

Health insurance companies would be required to include detailed information about denied claims in their yearly reports to workers, making it easier for employees to see how often their coverage is being rejected and for what reasons. This transparency requirement would help workers understand patterns in claim denials and potentially identify unfair practices by their health plans. The change affects employers who offer group health insurance and the workers covered under those plans.

AI-assisted summary generated from the official bill metadata (title, subjects, actions) sourced from Congress.gov. Cached and reviewed. Always verify against the official text linked below.

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 9754 Introduced in House (IH)] <DOC> 119th CONGRESS 2d Session H. R. 9754 To direct the Secretary of Labor to require group health plans include certain information on claim denials in annual reports, and for other purposes. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES July 16, 2026 Mrs. McBath introduced the following bill; which was referred to the Committee on Education and Workforce _______________________________________________________________________ A BILL To direct the Secretary of Labor to require group health plans include certain information on claim denials in annual reports, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the ``Health Claim Denial Transparency Act''. SEC. 2. CLAIM DENIAL TRANSPARENCY REGULATION. (a) Regulation.-- (1) In general.--Not later than 1 year after the date of enactment of this Act and subject to paragraph (2), the Secretary of Labor shall promulgate a regulation requiring all group health plans, as part of the annual report required under section 104(a)(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1024(a)(1)), to include, with respect to the plan year of the annual report, the following: (A) The total number of claims for benefits-- (i) submitted during the plan year; (ii) approved during the plan year; (iii) denied during the plan year; (iv) appealed during the plan year; and (v) of the claims described in clause (iv), the number of claim denials reversed in whole or in part during the appeals process. (B) The number of pre-service, post-service, and urgent care claims-- (i) submitted during the plan year; (ii) approved during the plan year; (iii) denied during the plan year; and (iv) appealed during the plan year. (C) The number of in-patient and out-patient claims-- (i) submitted during the plan year; (ii) approved during the plan year; (iii) denied during the plan year; and (iv) appealed during the plan year. (D) Subject to paragraph (2), the number of claims for prescription drugs-- (i) submitted during the plan year; (ii) denied during the plan year; (iii) approved during the plan year; and (iv) appealed during the plan year. (E) Subject to paragraph (2), the number of claims for mental health and substance use disorder benefits-- (i) submitted during the plan year; (ii) denied during the plan year; (iii) approved during the plan year; and (iv) appealed during the plan year. (F) Subject to paragraph (2), the number of claims for medical and surgical benefits relating to the diagnosis or treatment of cancer-- (i) submitted during the plan year; (ii) denied during the plan year; (iii) approved during the plan year; and (iv) appealed during the plan year. (G) The total dollar amount of-- (i) claims paid during the plan year; and (ii) claims denied during the plan year. (H) The total number of claims that were not adjudicated within the time frame required by the claims procedure process of the plan, established pursuant to section 503 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1133). (I) The basis for denials, including the total number of claims denied due to-- (i) medical necessity requirements; (ii) lack of referral; (iii) lack of prior authorization; (iv) services excluded; (v) administrative reasons; and (vi) other reasons determined by the Secretary. (J) The number of claims processed in which artificial intelligence or other automated decision- making tools are utilized, including the number of such claims-- (i) paid during the plan year; and (ii) denied during the plan…

year. (2) Exception for certain data from small plans.--The Secretary may not require that the annual report include, and a group health plan may not include in such report, the number of claims as described under subparagraph (D), (E), or (F) of paragraph (1) if the plan has received 20 or fewer unique claims described under the applicable paragraph during the plan year. (b) Amending Regulations.--As part of the promulgation described in subsection (a), the Secretary shall amend section 2520.104-46(b)(2) of title 29, Code of Federal Regulations, to require a group health plan with fewer than 100 participants to comply with the reporting requirements of subsection (a). (c) Waiver of Minimum Requirements.--In the case that the Secretary allows a group health plan to file a simplified report pursuant to section 104(a)(3) of the Employee Retirement Income Security Act (29 U.S.C. 1024(a)(3)), the Secretary shall, at a minimum, require the group health plan to include all of the information in subsection (a) in such simplified report. (d) Definitions.--In this section: (1) Denial.--The term ``denial'' has the meaning given the term ``adverse benefit determination'' in section 2560.503- 1(m)(4) of title 29, Code of Federal Regulations. (2) Group health plan.--The term ``group health plan'' has the meaning given the term in section 733(a)(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1191b(a)(1)). (3) Post-service claim.--The term ``post-service claim'' has the meaning given the term in section 2560.503-1(m) of title 29, Code of Federal Regulations. (4) Pre-service claim.--The term ``pre-service claim'' has the meaning given the term in section 2560.503-1(m) of title 29, Code of Federal Regulations. (5) Urgent care claim.--The term ``urgent care claim'' has the meaning given the term ``claim involving urgent care'' in section 2560.503-1(m)(1) of title 29, Code of Federal Regulations. <all>

• HR8937Early Childhood Workforce Advancement Act of 2026
  Referred to Committee · 2026-05-20
• HR8304CREATES Act
  Referred to Committee · 2026-04-15
• HR8055Extending WIC for New Moms Act
  Referred to Committee · 2026-03-24
• HR7599Federal Extreme Risk Protection Order Act of 2026
  Referred to Committee · 2026-02-17