After Man's Death Following Insurance Denials, West Virginia Tackles Prior Authorization

Six months aft Eric Tennant died pursuing a prolonged conflict pinch his wellness insurer complete doctor-recommended crab care, West Virginia’s Republican politician signed a measure intended to curb nan harms of security denials.

Tennant, a ember mining information coach from Bridgeport, died past September astatine property 58 from complications related to shape 4 crab of nan bile ducts. In early 2025, his insurer, nan state’s Public Employees Insurance Agency, repeatedly denied him coverage of a $50,000 noninvasive crab curen that would person utilized ultrasound waves to target, and perchance shrink, nan largest tumor successful his liver. His family didn’t expect nan process to eliminate nan cancer, but they hoped it would bargain him much clip and amended his value of life. The insurer said that nan procedure, called histotripsy, wasn’t medically basal and that it was considered “experimental and investigational.”

Eric Tennant pinch his wife, Becky, and daughter, Amiya.Rebecca Tennant

Becky Tennant, his widow, told members of a West Virginia House committee successful precocious February that she submitted aesculapian records, master opinions and information arsenic portion of respective attempts to entreaty nan denial. She besides reached retired to “almost each 1 of our authorities representatives,” asking for help.

Nothing worked, she told lawmakers, until KFF Health News and NBC News sewage involved and posed questions to nan Public Employees Insurance Agency astir her husband’s case. Only past did nan insurer reverse its determination and o.k. histotripsy, Tennant said.

“But by then, nan hold had already done its damage,” she said.

Within 1 week of nan reversal successful precocious May, Eric Tennant was hospitalized. His wellness continued to decline, and by midsummer he was nary longer considered a suitable campaigner for nan procedure. “The security company’s determination did not simply hold care. It closed doors,” his woman said.

West Virginia’s Public Employees Insurance Agency enrolls astir 215,000 group — authorities workers, arsenic good arsenic their spouses and dependents. The caller law, which will return effect June 10, will let scheme members who person been approved for a people of curen to prosecute an alternative, medically due curen of adjacent aliases lesser worth without nan request for different support from nan state-based wellness plan.

Eric Tennant, a authorities employee, was insured by West Virginia’s Public Employees Insurance Agency.NBC News

“This authorities is rooted successful a elemental principle: if a curen has already been approved, patients should beryllium capable to prosecute a medically due replacement without being forced to commencement nan process complete again — particularly erstwhile it does not costs more,” Gov. Patrick Morrisey said successful a statement.

“This is astir communal sense, compassion, and trusting patients and their doctors to make nan champion decisions for their care,” he said.

Had nan measure been successful effect past year, said Delegate Laura Kimble, nan Republican from Harrison who introduced nan legislation, Tennant could person undergone histotripsy without preapproval, because it was a little costly replacement to chemotherapy, which had already been authorized by nan insurer.

From Arizona to Rhode Island, astatine slightest half of each authorities legislatures person taken up bills this twelvemonth related to anterior authorization, a process that requires patients aliases their aesculapian squad to activity support from an insurer earlier proceeding pinch care. These authorities efforts travel arsenic patients crossed nan country await alleviation from anterior authorization hurdles, arsenic promised by dozens of awesome wellness insurers successful a promise announced by nan Trump management past year.

The West Virginia bill, passed unanimously by nan authorities legislature, was signed by Morrisey connected Tuesday. Kimble told KFF Health News nan measurement offers “a logical solution” for patients facing “the astir irrational and chaotic clip of their lives.”

Becky Tennant, left, and West Virginia Delegate Laura Kimble talk Eric Tennant’s security denial.NBC News

U.S. wellness insurers reason that astir anterior authorization requests are quickly, if not instantly, approved. AHIP, a wellness security manufacture waste and acquisition group, says anterior authorization acts arsenic an important guardrail successful preventing imaginable harm to patients and reducing unnecessary wellness attraction costs. But denials and delays thin to impact patients who request expensive, time-sensitive care, aggregate studies person shown.

Americans rank anterior authorization arsenic their biggest load erstwhile it comes to getting wellness care, according to a canvass published successful February by KFF, nan wellness accusation nonprofit that includes KFF Health News.

Samantha Knapp, a spokesperson for nan West Virginia Department of Administration, would not reply questions astir nan law’s financial effect connected nan state. “We for illustration to debar immoderate speculation astatine this clip regarding imaginable effect aliases actions,” Knapp said.

In a fiscal statement attached to nan bill, Jason Haught, nan Public Employee Insurance Agency’s main financial officer, said nan rule would costs nan agency an estimated $13 cardinal annually and “cause personnel disruption.”

By precocious 2025, West Virginia and 48 different states, successful summation to nan District of Columbia and Puerto Rico, already had immoderate shape of a anterior authorization rule — aliases aggregate specified laws — connected nan books, according to a study published successful December by nan National Association of Insurance Commissioners.

Many states person group up “gold carding” programs, which let physicians pinch a way grounds of approvals to bypass anterior authorization requirements. Some states found a maximum number of days security companies are allowed to respond to requests, while others prohibit security companies from issuing retrospective denials aft a work was already preauthorized. There are also a harvest of caller authorities laws seeking to modulate nan usage of artificial intelligence successful anterior authorization decision-making.

Becky and Eric Tennant fought for months to get Eric’s curen approved by his insurer. NBC News

Meanwhile, anterior authorization bills introduced this twelvemonth crossed nan country, including successful Kentucky, Missouri, and New Jersey, person been supported by politicians from some parties.

“Republicans successful blimpish states spot wellness attraction arsenic a vulnerability for nan midterm elections, and so, unsurprisingly, you’ll spot immoderate action connected this,” said Robert Hartwig, a objective subordinate professor of consequence management, insurance, and finance astatine nan University of South Carolina. “They recognize that they’re not really going to get overmuch action astatine nan national level fixed nan grade of gridlock we’ve already seen.”

Last summer, nan Trump administration announced a pledge signed by dozens of wellness insurers vowing to betterment anterior authorization. The insurers promised to trim nan scope of claims that require preapproval, alteration hold times and pass pinch patients successful clear connection erstwhile denying a request.

Consumers, diligent advocates and aesculapian providers person expressed skepticism that companies will travel done connected their promises.

Becky Tennant is skeptical, too. That’s why she advocated for nan West Virginia bill.

“Families should not person to beg, appeal, aliases spell nationalist conscionable to entree time-sensitive care,” she told lawmakers. Tennant, who sees nan bill’s transition arsenic bittersweet, said she thought her hubby would person been proud.

During Eric Tennant’s last infirmary stay, she recalled, correct earlier he was discharged to location hospice care, she asked him whether he wanted her to support fighting to alteration nan authorities agency’s anterior authorization process.

“‘Well, you request to astatine slightest effort to alteration it,’” she recalled her hubby saying. “‘Because it’s not fair.’”

“I told him I would support trying,” she said, “at slightest for a while. And truthful I americium keeping that committedness to him.”