Health Claim Denial Transparency Act

Key Points

• The bill would require nearly all employer group health plans to report detailed yearly data on claims submitted, approved, denied, and appealed to the Department of Labor.
• Plans must break the data down by category, including prescription drugs, mental health and substance use disorder care, and cancer treatment, so patterns of denial in specific types of care can be tracked.
• For the first time, plans would have to report how many claims were decided using artificial intelligence or other automated tools, and how many of those were denied.
• Even small employer plans with fewer than 100 participants would have to follow these reporting rules, closing a gap that previously let smaller plans skip detailed disclosure.
• Plans must also list the specific reasons behind denials, such as lack of medical necessity, missing referrals, or missing prior authorization, making it easier to see why claims are being rejected.