If a procedure is preauthorized, that approval must mean something. Patients should never undergo surgery believing they are covered, only to be hit later with a denial to be litigated.

- Once an insurer approves a procedure through prior authorization, the approval must be honored and cannot be retroactively denied after treatment is performed, except in cases of proven fraud
- Insurance companies may not claw back payments from hospitals or physicians for procedures they previously authorized
- Shield patients from financial liability for care their insurer already approved and impose penalties, automatic reimbursement requirements, and enforcement actions for wrongful post-care denials

Insurance companies increasingly use automated systems to deny care and claims at scale. Medical decisions should never be made by unchecked algorithms.

- Prohibit fully automated claim or treatment denials without human medical review
- Require insurers to disclose when AI systems influence claim decisions
- Mandate physician oversight for algorithm-assisted denial decisions and establish federal audit standards for insurer algorithms

Too many patients are denied coverage through confusing paperwork, vague denial language, or appeals systems built to wear them down. If a company denies care, it should have to clearly explain why and give patients a fair chance to challenge it.

- Require plain-language denial notices with specific medical and contractual reasons, with requirements for continuity of care protections during active appeals for serious conditions
- Guarantee a fast, independent external appeals process, penalizing repeat wrongful denials and bad-faith claims practices
- Any claim denial based on medical necessity must be reviewed and signed off by a licensed physician practicing in the same specialty as the treating provider

Medical decisions should be made by patients and licensed medical professionals, not by insurance corporations, pharmacy benefit managers, or hospital finance departments.

- Ban corporate lobbying of physicians and prohibit drug and device companies from offering payments, gifts, or incentives to influence prescribing habits or treatment choices
- Protect clinical autonomy so doctors can prescribe or recommend treatment based on medical need and professional judgment
- Restrict undue interference from insurers, PBMs, and hospital systems in treatment recommendations and create oversight standards that protect patients without replacing physician judgment with corporate protocols

Patients should not have to pay more for medicine because a private middleman controls formularies, pharmacy access, reimbursement, and rebate flows behind closed doors.

- Prohibit insurers and employer health plans from outsourcing prescription benefit control to PBMs after a transition period
- Prevent any entity administering drug benefits from steering patients into affiliated pharmacies or using reimbursement models that undercut independent pharmacies.
- Any negotiated discount must go directly to the health plan or patient at the point of sale, with no middleman skimming, and require full reporting of reimbursement terms, fees, formularies, and discount flows so patients and regulators can see where the money goes.

Prior authorization has become one of the most abused tools in the insurance system, often used to delay care until a patient gets sicker or gives up.

- Set strict deadlines for prior authorization decisions and require automatic approval when insurers fail to respond in time
- Exempt routine, continuing, and already established treatments from repeated authorization requirements
- Require physician-led review for denials rather than anonymous corporate reviewers

Insurance companies should not be allowed to profit by owning the very services they push patients into using. When insurers have financial stakes in provider networks, medical integrity is put at risk.

- Prohibit insurers from owning or holding major controlling stakes in hospitals, clinics, pharmacies, diagnostic labs, or treatment providers used by their members
- Ban insurer self-referral practices that pressure patients into corporate-owned care pathways
- Require full public disclosure of insurer financial interests across healthcare entities and establish strong conflict-of-interest enforcement and structural separation requirements

Patients deserve to know the cost of care before they receive it. Transparent pricing empowers families to make informed decisions, prevents surprise billing, and restores accountability to our healthcare system

- Insurance companies, hospitals, clinics, and treatment facilities must publicly list the expected cost of services and procedures before care is delivered
- Require healthcare providers and insurers to publish pricing in clear, standardized formats that patients can easily compare across facilities and services.
- Establish federal penalties for providers and insurers that fail to disclose accurate pricing or intentionally obscure the true cost of care.