After man’s death following insurance denials, West Virginia tackles prior authorization

Six months after Eric Tennant died following a protracted battle with his health insurer over doctor-recommended cancer care, West Virginia’s Republican governor signed a bill intended to curb the harms of insurance denials.

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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’s 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’t 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’t medically necessary and that it was considered “experimental and investigational.”

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 “almost every one of our state representatives,” asking for help.

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’s case. Only then did the insurer reverse its decision and approve histotripsy, Tennant said.

“But by then, the delay had already done its damage,” she said.

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. “The insurance company’s decision did not simply delay care. It closed doors,” his wife said.

West Virginia’s Public Employees Insurance Agency enrolls nearly 215,000 people — 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.

“This 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 — especially when it does not cost more,” Gov. Patrick Morrisey said in a statement.

“This is about common sense, compassion, and trusting patients and their doctors to make the best decisions for their care,” he said.

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.

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.

The West Virginia bill, passed unanimously by the state legislature, was signed by Morrisey on Tuesday. Kimble told KFF Health News the measure offers “a rational solution” for patients facing “the most irrational and chaotic time of their lives.”

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.

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.

Samantha Knapp, a spokesperson for the West Virginia Department of Administration, would not answer questions about the law’s financial impact on the state. “We prefer to avoid any speculation at this time regarding potential impact or actions,” Knapp said.

In a fiscal note attached to the bill, Jason Haught, the Public Employee Insurance Agency’s chief financial officer, said the law would cost the agency an estimated $13 million annually and “cause member disruption.”

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 — or multiple such laws — on the books, according to a report published in December by the National Association of Insurance Commissioners.

Many states have set up “gold carding” 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.

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.

“Republicans in conservative states see health care as a vulnerability for the midterm elections, and so, unsurprisingly, you’ll see some action on this,” said Robert Hartwig, a clinical associate professor of risk management, insurance, and finance at the University of South Carolina. “They realize that they’re not really going to get much action at the federal level given the degree of gridlock we’ve already seen.”

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.

Consumers, patient advocates and medical providers have expressed skepticism that companies will follow through on their promises.

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

“Families should not have to beg, appeal, or go public just to access time-sensitive care,” she told lawmakers. Tennant, who sees the bill’s passage as bittersweet, said she thought her husband would have been proud.

During Eric Tennant’s 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’s prior authorization process.

“‘Well, you need to at least try to change it,’” she recalled her husband saying. “‘Because it’s not fair.’”

“I told him I would keep trying,” she said, “at least for a while. And so I am keeping that promise to him.”