Six months after Eric Tennant died following a protracted battle with his health insurer over doctor-recommended cancer care, West Virginia\u2019s Republican governor signed a bill intended to curb the harms of insurance denials.<\/p>\n\n\n\n
Tennant, a coal mining safety instructor from Bridgeport, died last September at age 58 from complications related to stage 4 cancer of the bile ducts. In early 2025, his insurer, the state\u2019s Public Employees Insurance Agency, repeatedly denied him coverage of a $50,000 noninvasive cancer treatment that would have used ultrasound waves to target, and potentially shrink, the largest tumor in his liver. His family didn\u2019t expect the procedure to eradicate the cancer, but they hoped it would buy him more time and improve his quality of life. The insurer said that the procedure, called histotripsy, wasn\u2019t medically necessary and that it was considered \u201cexperimental and investigational.\u201d<\/p>\n\n\n\n
Becky Tennant, his widow, told members of a West Virginia House committee in late February that she submitted medical records, expert opinions and data as part of several attempts to appeal the denial. She also reached out to \u201calmost every one of our state representatives,\u201d asking for help.<\/p>\n\n\n\n
Nothing worked, she told lawmakers, until KFF Health News and NBC News got involved and posed questions to the Public Employees Insurance Agency about her husband\u2019s case. Only then did the insurer reverse its decision and approve histotripsy, Tennant said.<\/p>\n\n\n\n
\u201cBut by then, the delay had already done its damage,\u201d she said.<\/p>\n\n\n\n
Within one week of the reversal in late May, Eric Tennant was hospitalized. His health continued to decline, and by midsummer he was no longer considered a suitable candidate for the procedure. \u201cThe insurance company\u2019s decision did not simply delay care. It closed doors,\u201d his wife said.<\/p>\n\n\n\n
West Virginia\u2019s Public Employees Insurance Agency enrolls nearly 215,000 people \u2014 state workers, as well as their spouses and dependents. The new law, which will take effect June 10, will allow plan members who have been approved for a course of treatment to pursue an alternative, medically appropriate treatment of equal or lesser value without the need for another approval from the state-based health plan.<\/p>\n\n\n\n
\u201cThis legislation is rooted in a simple principle: if a treatment has already been approved, patients should be able to pursue a medically appropriate alternative without being forced to start the process over again \u2014 especially when it does not cost more,\u201d Gov. Patrick Morrisey said in a statement.<\/p>\n\n\n\n
\u201cThis is about common sense, compassion, and trusting patients and their doctors to make the best decisions for their care,\u201d he said.<\/p>\n\n\n\n
Had the bill been in effect last year, said Delegate Laura Kimble, the Republican from Harrison who introduced the legislation, Tennant could have undergone histotripsy without preapproval, because it was a less expensive alternative to chemotherapy, which had already been authorized by the insurer.<\/p>\n\n\n\n
From Arizona to Rhode Island, at least half of all state legislatures have taken up bills this year related to prior authorization, a process that requires patients or their medical team to seek approval from an insurer before proceeding with care. These state efforts come as patients across the country await relief from prior authorization hurdles, as promised by dozens of major health insurers in a pledge announced by the Trump administration last year.<\/p>\n\n\n\n
The West Virginia bill, passed unanimously by the state legislature, was signed by Morrisey on Tuesday. Kimble told KFF Health News the measure offers \u201ca rational solution\u201d for patients facing \u201cthe most irrational and chaotic time of their lives.\u201d<\/p>\n\n\n\n
U.S. health insurers argue that most prior authorization requests are quickly, if not instantly, approved. AHIP, a health insurance industry trade group, says prior authorization acts as an important guardrail in preventing potential harm to patients and reducing unnecessary health care costs. But denials and delays tend to affect patients who need expensive, time-sensitive care, multiple studies have shown.<\/p>\n\n\n\n
Americans rank prior authorization as their biggest burden when it comes to getting health care, according to a poll published in February by KFF, the health information nonprofit that includes KFF Health News.<\/p>\n\n\n\n
Samantha Knapp, a spokesperson for the West Virginia Department of Administration, would not answer questions about the law\u2019s financial impact on the state. \u201cWe prefer to avoid any speculation at this time regarding potential impact or actions,\u201d Knapp said.<\/p>\n\n\n\n
In a fiscal note attached to the bill, Jason Haught, the Public Employee Insurance Agency\u2019s chief financial officer, said the law would cost the agency an estimated $13 million annually and \u201ccause member disruption.\u201d<\/p>\n\n\n\n
By late 2025, West Virginia and 48 other states, in addition to the District of Columbia and Puerto Rico, already had some form of a prior authorization law \u2014 or multiple such laws \u2014 on the books, according to a report published in December by the National Association of Insurance Commissioners.<\/p>\n\n\n\n
Many states have set up \u201cgold carding\u201d programs, which allow physicians with a track record of approvals to bypass prior authorization requirements. Some states establish a maximum number of days insurance companies are allowed to respond to requests, while others prohibit insurance companies from issuing retrospective denials after a service was already preauthorized. There are also a crop of new state laws seeking to regulate the use of artificial intelligence in prior authorization decision-making.<\/p>\n\n\n\n
Meanwhile, prior authorization bills introduced this year across the country, including in Kentucky, Missouri, and New Jersey, have been supported by politicians from both parties.<\/p>\n\n\n\n
\u201cRepublicans in conservative states see health care as a vulnerability for the midterm elections, and so, unsurprisingly, you\u2019ll see some action on this,\u201d said Robert Hartwig, a clinical associate professor of risk management, insurance, and finance at the University of South Carolina. \u201cThey realize that they\u2019re not really going to get much action at the federal level given the degree of gridlock we\u2019ve already seen.\u201d<\/p>\n\n\n\n
Last summer, the Trump administration announced a pledge signed by dozens of health insurers vowing to reform prior authorization. The insurers promised to reduce the scope of claims that require preapproval, decrease wait times and communicate with patients in clear language when denying a request.<\/p>\n\n\n\n
Consumers, patient advocates and medical providers have expressed skepticism that companies will follow through on their promises.<\/p>\n\n\n\n
Becky Tennant is skeptical, too. That\u2019s why she advocated for the West Virginia bill.<\/p>\n\n\n\n
\u201cFamilies should not have to beg, appeal, or go public just to access time-sensitive care,\u201d she told lawmakers. Tennant, who sees the bill\u2019s passage as bittersweet, said she thought her husband would have been proud.<\/p>\n\n\n\n
During Eric Tennant\u2019s final hospital stay, she recalled, right before he was discharged to home hospice care, she asked him whether he wanted her to keep fighting to change the state agency\u2019s prior authorization process.<\/p>\n\n\n\n
\u201c\u2018Well, you need to at least try to change it,\u2019\u201d she recalled her husband saying. \u201c\u2018Because it\u2019s not fair.\u2019\u201d<\/p>\n\n\n\n
\u201cI told him I would keep trying,\u201d she said, \u201cat least for a while. And so I am keeping that promise to him.\u201d<\/p>\n\n\n\n