Months, or even years, after a service is provided and paid for, insurers can demand repayment, often with little explanation and no clear timeline. These retroactive recoupments create financial instability for providers, disrupt care, and ultimately limit access for the communities we serve.

House Bill 4280, introduced by Representative VanderWall, takes an important step toward fixing this problem.

What HB 4280 Would Do

• Establish clearer limits (90 days) on when insurers can seek recoupment
• Increase transparency in how and why clawbacks are issued
• Create more predictable and fair processes for providers
• Reduce administrative burden and financial uncertainty

Why It Matters

Clawbacks don’t just impact providers—they impact access to care.

When providers face unpredictable repayment demands:

• Small and independent practices are disproportionally impacted
• Fewer providers are able to accept insurance due to the associated high risks
• Patients experience delays, disruptions, or loss of care

This legislation helps ensure providers can continue serving their communities without fear of sudden financial penalties.