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

Six months after a West Virginia man died following a long battle with his health insurer over doctor-recommended cancer care, the state’s Republican governor signed a bill intended to reduce the harm caused by insurance denials.

The West Virginia Public Employees Insurance Agency enrolls nearly 215,000 people – public employees, as well as their spouses and dependents. The new law, which takes effect June 10, will allow plan members who have been approved for treatment to pursue an alternative, medically appropriate treatment of equal or lesser value without needing further approval from the state health plan.

“This legislation is based on 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 again – especially if it does not cost more,” Governor Patrick Morrisey said in a statement after signing the bill on March 31.

“It’s about using common sense, compassion and trusting patients and their doctors to make the best decisions about their care,” he said.

Delegate Laura Kimble, a Republican from Harrison, West Virginia, who introduced the legislation, told KFF Health News the measure offers “a rational solution” for patients facing “the most irrational and chaotic time of their lives.”

From Arizona to Rhode Island, at least half of all state legislatures have passed bills this year related to prior authorization, a process that requires patients or their medical teams to seek approval from an insurer before proceeding with care. These state efforts come as patients across the country wait for 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 law was inspired by Eric Tennant, a Bridgeport coal mine safety instructor who died Sept. 17 at age 58. In early 2025, the Public Employees Insurance Agency repeatedly denied him coverage for a $50,000 non-invasive cancer treatment called histotripsy, which would have used ultrasound waves to target, and potentially shrink, the largest tumor in his liver. Her family didn’t expect the procedure to eradicate the cancer, but they hoped it would save her more time and improve her quality of life. The insurer said the procedure was not medically necessary and was considered “experimental and experimental.”

Becky Tennant, Eric’s widow, told members of a West Virginia House committee in late February that she had submitted medical records, expert opinions and data in several attempts to appeal the denial. She also contacted “nearly every representative in our state” to ask for help.

Nothing worked, she told lawmakers, until KFF Health News and NBC News got involved and asked the Public Employees Insurance Agency about Eric’s case. Only then did the insurer reverse its decision and approve histotripsy, Tennant said.

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

Less than a week after the overthrow in late May, Eric Tennant was hospitalized. His health continued to deteriorate and by mid-summer he was no longer considered a suitable candidate for the procedure. “The insurance company’s decision didn’t just delay care. It closed the doors,” his wife said.

If the new law had been in effect, Kimble said, Tennant could have undergone histotripsy without prior authorization because it was a less expensive alternative to chemotherapy, which his insurer had already authorized. The bill passed the state legislature unanimously in March.

U.S. health insurers say most prior authorization requests are approved quickly, if not instantly. AHIP, the health insurance industry trade group, declares prior authorization acts as an important safeguard to prevent potential harm to patients and reduce unnecessary healthcare costs. But denials and delays tend to affect patients who need expensive and urgent care, studies show.

The practice has come under scrutiny in recent years, particularly after the fatal shooting of a health insurance executive in New York in late 2024. Americans view prior authorization as their biggest burden when it comes to getting health care, according to a poll released in February by KFF, a nonprofit health news organization that includes KFF Health News.

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

In a fiscal note attached to the bill, Jason Haught, chief financial officer of the Public Employees Insurance Agency, said the law would cost the agency about $13 million a year and “cause disruption for members.”

West Virginia is not an exception when it comes to prior authorization. By the end of 2025, 48 other states, in addition to the District of Columbia and Puerto Rico, already had one or more forms of prior authorization law or laws, according to a report released in December by the National Association of Insurance Commissioners.

Many states have implemented “gold carding” programs, which allow physicians with a history of approvals to bypass prior authorization requirements. Some states set a maximum number of days that insurance companies are allowed to respond to claims, while others prohibit insurance companies from issuing retroactive denials after a service has already been pre-authorized. There are also a series of new state laws aimed at regulating 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 in both parties.

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

Last summer, the Trump administration announced a pledge signed by dozens of health insurers pledging to reform prior authorization. Insurers have promised to reduce the scope of claims that require pre-approval, reduce wait times and communicate clearly with patients when they deny a claim.

Consumers, patient advocates and medical providers have expressed skepticism that companies can deliver on their promises.

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

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

During Eric’s last hospital stay, Tennant recalls, just before he was discharged to home hospice care, she asked him if he wanted her to continue fighting to change the state agency’s prior authorization process.

“Well, you have to at least try to change him,” she remembers telling her husband. “Because it’s not fair. »

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

NBC News Health and Medical Unit Producer Jason Kane and Correspondent Erin McLaughlin contributed to this report.

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