Lauren Sausser
Six months after a West Virginia man died following a protracted battle along with his well being insurer over doctor-recommended most cancers care, the state’s Republican governor signed a invoice meant to curb the hurt of insurance coverage denials.
West Virginia’s Public Employees Insurance Agency enrolls practically 215,000 individuals — state staff, in addition to their spouses and dependents. The new legislation, which is able to take impact June 10, will enable plan members who’ve been authorized for a course of remedy to pursue an alternate, medically acceptable remedy of equal or lesser worth with out the necessity for one more approval from the state-based well being 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 mentioned in an announcement after signing the invoice into legislation on March 31.
“This is about common sense, compassion, and trusting patients and their doctors to make the best decisions for their care,” he mentioned.
Delegate Laura Kimble, the Republican from Harrison County who launched the laws, informed KFF Health News the measure presents “a rational solution” for sufferers dealing with “the most irrational and chaotic time of their lives.”
From Arizona to Rhode Island, a minimum of half of all state legislatures have taken up payments this yr associated to prior authorization, a course of that requires sufferers or their medical staff to hunt approval from an insurer earlier than continuing with care. These state efforts come as sufferers throughout the nation await relief from prior authorization hurdles, as promised by dozens of main well being insurers in a pledge introduced by the Trump administration final yr.
The West Virginia legislation was impressed by Eric Tennant, a coal-mining security teacher from Bridgeport who died on Sept. 17 at age 58. In early 2025, the Public Employees Insurance Agency repeatedly denied him coverage of a $50,000 noninvasive most cancers remedy, referred to as histotripsy, that might have used ultrasound waves to focus on, and probably shrink, the biggest tumor in his liver. His household didn’t anticipate the process to eradicate the most cancers, however they hoped it will purchase him extra time and enhance his high quality of life. The insurer mentioned the process wasn’t medically obligatory and that it was thought of “experimental and investigational.”
Becky Tennant, Eric’s widow, informed members of a West Virginia House committee in late February that she submitted medical data, skilled opinions, and knowledge as a part of a number of makes an attempt to attraction the denial. She additionally reached out to “almost every one of our state representatives,” asking for assist.
Nothing labored, she informed lawmakers, till KFF Health News and NBC News got involved and posed inquiries to 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 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.
Had the new law been in effect, Kimble said, Tennant could have undergone histotripsy without preapproval, because it was a less expensive alternative to chemotherapy, which his insurer had already authorized. The bill was passed unanimously by the state legislature in March.
U.S. health insurers argue that most prior authorization requests are quickly, if not instantly, approved. AHIP, the health insurance industry trade group, says prior authorization acts as an important guardrail in stopping potential hurt to sufferers and decreasing pointless well being care prices. But denials and delays are inclined to have an effect on sufferers who want costly, time-sensitive care, studies have shown.
The follow has come beneath intense scrutiny lately, significantly after the fatal shooting of a health insurance executive in New York City in late 2024. Americans rank prior authorization as their largest burden relating to getting well being care, based on a poll published in February by KFF, a well being data nonprofit that features KFF Health News.
Samantha Knapp, a spokesperson for the West Virginia Department of Administration, wouldn’t reply questions concerning the legislation’s monetary impression on the state. “We prefer to avoid any speculation at this time regarding potential impact or actions,” Knapp mentioned.
In a fiscal word connected to the invoice, Jason Haught, the Public Employees Insurance Agency’s chief monetary officer, mentioned the legislation would value the company an estimated $13 million yearly and “cause member disruption.”
West Virginia isn’t an outlier in focusing on prior authorization. By late 2025, 48 different states, along with the District of Columbia and Puerto Rico, already had some type of a previous authorization legislation — or legal guidelines — on the books, based on a report published in December by the National Association of Insurance Commissioners.
Many states have arrange “gold carding” applications, which permit physicians with a monitor file of approvals to bypass prior authorization necessities. Some states set up a most variety of days insurance coverage corporations are allowed to reply to requests, whereas others prohibit insurance coverage corporations from issuing retrospective denials after a service has already been preauthorized. There are additionally a crop of new state laws looking for to control the usage of synthetic intelligence in prior authorization decision-making.
Meanwhile, prior authorization payments launched this yr throughout the nation, together with in Kentucky, Missouri, and New Jersey, have been supported by politicians from each events.
“Republicans in conservative states see health care as a vulnerability for the midterm elections, and so, unsurprisingly, you’ll see some action on this,” mentioned Robert Hartwig, a medical affiliate professor of threat administration, insurance coverage, and finance on 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 season, the Trump administration announced a pledge signed by dozens of well being insurers vowing to reform prior authorization. The insurers promised to cut back the scope of claims that require preapproval, lower wait instances, and talk with sufferers in clear language when denying a request.
Consumers, affected person advocates, and medical suppliers have expressed skepticism that corporations will observe by way of on their guarantees.
Becky Tennant is skeptical, too. That’s why she advocated for the West Virginia invoice.
“Families should not have to beg, appeal, or go public just to access time-sensitive care,” she informed lawmakers. Tennant, who sees the invoice’s passage as bittersweet, mentioned she thought her husband would have been proud.
During Eric’s closing hospital keep, Tennant recalled, proper earlier than he was discharged to residence hospice care, she requested him whether or not he needed her to maintain preventing to alter the state company’s prior authorization course of.
“‘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 mentioned, “at least for a while. And so I am keeping that promise to him.”
NBC News well being and medical unit producer Jason Kane and correspondent Erin McLaughlin contributed to this report.
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