Eric Tennant with his wife Becky and his daughter Amiya. (Photo courtesy of Becky Tennant)
Six months after a West Virginia man died after a protracted dispute with his health insurer over doctor-recommended cancer treatment, the state’s Republican governor signed a bill aimed at curbing the damage of insurance denials.
The Public Employees Insurance Agency in West Virginia enrolls nearly 215,000 people – state employees and their spouses and dependents. The fresh law, effective June 10, allows plan members who have been approved for treatment to receive alternative, medically appropriate treatment of equal or lesser value without requiring further approval from the state health plan.
“This legislation is based on a simple principle: When a treatment has already been approved, patients should be able to pursue a medically appropriate alternative without being forced to begin the process again — especially if it does not cost more,” Gov. Patrick Morrisey said in a statement after signing the bill March 31.
“This is about common sense, compassion and trusting patients and their doctors to make the best decisions for their care,” he said.
Del. Laura Kimble, the Republican from Harrison County, West Virginia, who introduced the bill, 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 this year have approved bills related to prior authorization, a process that requires patients or their medical team to get approval from an insurer before proceeding with treatment. These government efforts are happening across the country waiting for relief from prior approval hurdlesas promised by dozens of major health insurers in a pledge announced by the Trump administration last year.
West Virginia’s law was inspired by Eric Tennanta coal mining safety instructor from Bridgeport who died Sept. 17 at age 58. In early 2025, the Public Employees Insurance Agency repeatedly refused him cover a $50,000 non-invasive cancer treatment called histotripsy, which would have used ultrasound waves to target the largest tumor in his liver and potentially shrink it. His family didn’t expect the procedure to eradicate the cancer, but hoped it would buy him more time and improve his quality of life. The insurer said the procedure was not medically necessary and was considered “experimental and investigative.”
Becky Tennant, Eric’s widow, told members of a West Virginia House committee in tardy February that she had 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” and asked for facilitate.
Nothing worked, she told lawmakers, until KFF Health News and NBC News participated and asked the Public Employees Insurance Agency questions about Eric’s case. Only then The insurer reversed its decision and approved the histotripsy, Tennant said.
“But by that point the delay had already done its damage,” she said.
Within a week of the U-turn in tardy May, Eric Tennant was hospitalized. His health continued to deteriorate and by midsummer he was no longer considered a suitable candidate for the procedure. “The insurance company’s decision didn’t just delay treatment. It closed doors,” his wife said.
Had the fresh law taken effect, Tennant would have been able to undergo histotripsy without prior authorization, Kimble said, because it was a cheaper alternative to chemotherapy, which his insurer had already approved. The bill was unanimously passed by the state parliament in March.
U.S. health insurers argue that most preauthorization requests are approved quickly, if not immediately. AHIP, the health insurance industry trade group, says prior authorization acts as an critical guardrail to prevent potential harm to patients and reduce unnecessary healthcare costs. But denials and delays tend to impact patients who need pricey and time-sensitive care. Studies have shown.
The practice has come under intense scrutiny in recent years, particularly after fatal shooting of a health insurance manager in New York City in tardy 2024. Americans consider prior authorization to be their biggest burden when it comes to health care, according to a Survey published in February from KFF, a nonprofit health information organization that also includes KFF Health News.
Samantha Knapp, a spokeswoman for the West Virginia Department of Administration, declined to answer questions about the law’s financial impact on the state. “We prefer to avoid speculation about possible impacts or actions at this time,” Knapp said.
In a financial note accompanying the bill, Jason Haught, chief financial officer of the Public Employees Insurance Agency, said the law would cost the agency an estimated $13 million annually and “lead to unrest among members.”
West Virginia is no outlier when it comes to pre-approval. By the end of 2025, 48 other states, in addition to the District of Columbia and Puerto Rico, already had some type of prior authorization law – or laws – on the books, according to one Report published in December from the National Association of Insurance Commissioners.
Many states have adopted “gold carding” programs that allow physicians with a track record of licensing success to bypass prior authorization requirements. Some states set a maximum number of days that insurance companies are allowed to respond to requests, while others prohibit insurance companies from issuing retroactive denials after a service has already been pre-approved. There are also a number of fresh state laws The aim is to regulate the apply of artificial intelligence in pre-approval decision-making.
Meanwhile, prior authorization bills supported by politicians from both parties have been introduced across the country this year, including in Kentucky, Missouri and New Jersey.
“Republicans in conservative states see health care as a weak point heading into the midterm elections, and so it’s not surprising to see some action in this area,” said Robert Hartwig, clinical associate professor of risk management, insurance and finance at the University of South Carolina. “They’re clear that they’re not really going to do much at the federal level given the level of shutdown we’ve already experienced.”
Last summer, the Trump administration announced a commitment signed by dozens of health insurers promising to reform prior authorization. Insurers promised to reduce the volume of claims requiring pre-approval, shorten wait times and communicate clearly with patients when a claim is rejected.
Consumers, patient advocates and medical providers have expressed skepticism that companies keep their promises.
Becky Tennant is also skeptical. That’s why she championed West Virginia’s bill.
“Families should not have to beg, appeal or go to the 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’s final hospitalization, Tennant recalled, shortly before he was discharged to home hospice care, she asked him if he wanted her to continue fighting for a change to the state agency’s prior authorization process.
“‘Well, you have 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 that’s why I’m keeping that promise to him.”
