Protecting Approved Care Act

The Protecting Approved Care Act would amend Medicare Advantage rules to prevent insurance companies from retroactively denying coverage for medical services that have already been approved or received by patients. Starting in 2028, plans would be prohibited from rejecting claims based on a lack of medical necessity if the service was authorized during the patient's care or did not require prior approval. Additionally, insurers could only reopen payment decisions or lower reimbursement amounts if there is good cause or reliable evidence of fraud, thereby protecting beneficiaries from unexpected claim reversals after treatment has occurred.