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Congress Introduces Protecting Approved Care Act to Shield Seniors From Medical Denials
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Key points
- The Protecting Approved Care Act was introduced as HR 10394 to prevent Medicare Advantage plans from retroactively denying previously approved medical coverage.
- The bipartisan bill was sponsored by Representative Greg Landsman and co-sponsored by Representative Bob Onder.
- Key provisions prohibit insurers from reopening approved coverage decisions, downcoding billing codes, or denying coverage for services that do not require prior authorization.
NewsWK — Federal lawmakers have introduced a new bipartisan bill designed to shield American seniors from unexpected medical bill denials. The proposed legislation targets private insurance companies that retroactively reject coverage for treatments they previously approved.
Why it matters
This bill directly impacts millions of older Americans who rely on private Medicare plans for their healthcare. By restricting retroactive denials, the legislation provides financial predictability for families. It also reduces administrative burdens on local healthcare providers. Ultimately, it ensures that approved care remains covered, preventing unexpected, costly medical bills for vulnerable seniors.
What are the key details of the HR 10394 Medicare Advantage claims denial legislation?
The HR 10394 Medicare Advantage claims denial legislation establishes strict federal guidelines to prevent insurance companies from reversing prior authorizations. Introduced on September 15, 2026, the bill stops insurers from retroactively denying coverage for previously approved procedures. This change brings much-needed security to patients navigating complex healthcare systems.
The legislation, formally titled the Protecting Approved Care Act, includes several critical protections for patients:
- It bans insurers from reopening coverage decisions after granting authorization, except in cases of fraud.
- It stops insurance companies from downcoding billing codes to reduce payments to doctors.
- It extends these same protections to covered medical services that do not require advance approval.
Who is sponsoring the Greg Landsman Medicare Advantage bill?
Representative Greg Landsman sponsored the Greg Landsman Medicare Advantage bill. Missouri Republican Bob Onder co-sponsored the legislation. This bipartisan effort shows growing congressional concern over insurance practices. Currently, the House Committee on Ways and Means and the Committee on Energy and Commerce are reviewing the proposal. If passed, the bill will amend Title XVIII of the Social Security Act to enforce these new patient protections nationwide.
This article was produced with the assistance of AI and reviewed by our editorial team.
Sources
Related: Medicare Access to Radiology Care Act Introduced in Congress
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