Six months after a West Virginia man died following a protracted battle together with his well being insurer over doctor-recommended most cancers care, the state’s Republican governor signed a invoice supposed to curb the hurt of insurance coverage denials.
West Virginia’s Public Workers Insurance coverage Company enrolls practically 215,000 individuals — state staff, in addition to their spouses and dependents. The brand new legislation, which can take impact June 10, will permit plan members who’ve been authorised for a course of therapy to pursue another, medically acceptable therapy 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 a press release 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, West Virginia, who launched the laws, informed KFF Well being Information the measure affords “a rational solution” for sufferers dealing with “the most irrational and chaotic time of their lives.”
From Arizona to Rhode Island, not less than half of all state legislatures have taken up payments this 12 months associated to prior authorization, a course of that requires sufferers or their medical crew to hunt approval from an insurer earlier than continuing with care. These state efforts come as sufferers throughout the nation await reduction from prior authorization hurdles, as promised by dozens of main well being insurers in a pledge introduced by the Trump administration final 12 months.
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 Workers Insurance coverage Company repeatedly denied him protection of a $50,000 noninvasive most cancers therapy, referred to as histotripsy, that may have used ultrasound waves to focus on, and doubtlessly shrink, the most important tumor in his liver. His household didn’t anticipate the process to eradicate the most cancers, however they hoped it might purchase him extra time and enhance his high quality of life. The insurer mentioned the process wasn’t medically needed and that it was thought-about “experimental and investigational.”
Becky Tennant, Eric’s widow, informed members of a West Virginia Home committee in late February that she submitted medical information, skilled opinions, and information as a part of a number of makes an attempt to enchantment the denial. She additionally reached out to “almost every one of our state representatives,” asking for assist.
Nothing labored, she informed lawmakers, till KFF Well being Information and NBC Information received concerned and posed inquiries to the Public Workers Insurance coverage Company about Eric’s case. Solely then did the insurer reverse its resolution and approve histotripsy, Tennant mentioned.
“But by then, the delay had already done its damage,” she mentioned.
Inside one week of the reversal in late Could, Eric Tennant was hospitalized. His well being continued to say no, and by midsummer he was not thought-about an acceptable candidate for the process. “The insurance company’s decision did not simply delay care. It closed doors,” his spouse mentioned.
Had the brand new legislation been in impact, Kimble mentioned, Tennant might have undergone histotripsy with out preapproval, as a result of it was a inexpensive different to chemotherapy, which his insurer had already licensed. The invoice was handed unanimously by the state legislature in March.
U.S. well being insurers argue that the majority prior authorization requests are rapidly, if not immediately, authorised. AHIP, the medical health insurance trade commerce group, says prior authorization acts as an essential guardrail in stopping potential hurt to sufferers and lowering pointless well being care prices. However denials and delays are inclined to have an effect on sufferers who want costly, time-sensitive care, research have proven.
The follow has come beneath intense scrutiny in recent times, notably after the deadly capturing of a medical health insurance government in New York Metropolis in late 2024. Individuals rank prior authorization as their largest burden relating to getting well being care, in response to a ballot revealed in February by KFF, a well being info nonprofit that features KFF Well being Information.
Samantha Knapp, a spokesperson for the West Virginia Division of Administration, wouldn’t reply questions in regards to the legislation’s monetary affect on the state. “We prefer to avoid any speculation at this time regarding potential impact or actions,” Knapp mentioned.
In a fiscal word hooked up to the invoice, Jason Haught, the Public Workers Insurance coverage Company’s chief monetary officer, mentioned the legislation would price the company an estimated $13 million yearly and “cause member disruption.”
West Virginia isn’t an outlier in concentrating 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, in response to a report revealed in December by the Nationwide Affiliation of Insurance coverage Commissioners.
Many states have arrange “gold carding” applications, which permit physicians with a observe document of approvals to bypass prior authorization necessities. Some states set up a most variety of days insurance coverage firms are allowed to answer requests, whereas others prohibit insurance coverage firms from issuing retrospective denials after a service has already been preauthorized. There are additionally a crop of latest state legal guidelines looking for to control the usage of synthetic intelligence in prior authorization decision-making.
In the meantime, prior authorization payments launched this 12 months 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 scientific affiliate professor of threat administration, insurance coverage, and finance on the College 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.”
Final summer season, the Trump administration introduced a pledge signed by dozens of well being insurers vowing to reform prior authorization. The insurers promised to scale back the scope of claims that require preapproval, lower wait instances, and talk with sufferers in clear language when denying a request.
Shoppers, affected person advocates, and medical suppliers have expressed skepticism that firms will comply with via 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.
Throughout Eric’s remaining hospital keep, Tennant recalled, proper earlier than he was discharged to house hospice care, she requested him whether or not he wished her to maintain combating to vary 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 Information well being and medical unit producer Jason Kane and correspondent Erin McLaughlin contributed to this report.
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