For practically three years, Eric Tennant endured chemotherapy infusions, rounds of radiation, biopsies, and hospitalizations that left him weak and depleted.
“It’s good to be residence,” he mentioned after one hospital keep in early June, “but I’m drained and able to get on with issues.”
In 2023, Tennant, of Bridgeport, West Virginia, was recognized with cholangiocarcinoma, a uncommon most cancers of the bile ducts that had unfold all through his physique.
Not one of the preliminary therapies prescribed by his medical doctors had eradicated the most cancers. However a glimmer of hope got here in early 2025, when Tennant was beneficial for histotripsy, a comparatively new process that will use ultrasound waves to focus on, and probably destroy, the biggest tumor in his physique — in his liver.
“My dad was a little bit nervous as a result of it was one thing new, however it undoubtedly gave us some hope that he can be round a little bit bit longer,” mentioned Tennant’s daughter, Amiya.
There was only one hitch: His insurer wouldn’t pay for it.
Tennant, 58, died of most cancers on Sept. 17. His story illustrates how a bureaucratic course of referred to as prior authorization can devastate sufferers and their households.
It’s infeasible to depend the individuals harmed by this overwhelmingly unpopular follow, which, by delaying or denying care, helps drive well being insurers’ income. No authorities company or non-public group tracks such knowledge.
That mentioned, KFF Well being Information has heard from a whole lot of sufferers in recent times who declare that they or somebody of their household has been harmed by prior authorization. Greater than 1 in 4 physicians surveyed by the American Medical Affiliation in December mentioned that prior authorization had led to a critical hostile occasion for a affected person of their care. And eight% responded that prior authorization led to a incapacity, beginning defect, or demise.
In June, the Trump administration introduced a pledge, signed by dozens of personal insurers, to streamline prior authorization, which regularly requires sufferers or their medical groups to ask insurers for permission earlier than continuing with many kinds of care. It stays unclear when sufferers can count on to see enchancment.
The commitments “rely on the complete cooperation of the non-public insurance coverage sector” and can “take time to attain their full impact,” mentioned Andrew Nixon, a spokesperson for the Division of Well being and Human Providers. However the pledge exists, he mentioned, “to forestall tragic deaths like Eric’s from occurring by the hands of an inefficient system.”
Chris Bond, a spokesperson for AHIP, a medical insurance trade commerce group, mentioned he couldn’t communicate to any particular insurer’s prior authorization insurance policies. Broadly, although, he mentioned prior authorization “acts as a guardrail” to ensure medicines and coverings usually are not used inappropriately.
On the identical time, he mentioned, insurers acknowledge that sufferers could be annoyed when their doctor-recommended care is denied. That’s why “there’s a devoted effort throughout the trade to make the method extra simple, quicker, and less complicated for sufferers and suppliers,” Bond mentioned.
Within the meantime, the method continues to take its toll on individuals like Eric Tennant, whose grave diagnoses typically require costly well being care providers.
“Eric is gone,” his widow, Becky, mentioned. “He’s not coming again.”
Tennant was a security teacher for the West Virginia Workplace of Miners’ Well being Security and Coaching and insured by the state’s Public Workers Insurance coverage Company, which contracts with UnitedHealthcare to manage advantages for state workers, their spouses, and dependents.
In February and March, UnitedHealthcare, the Public Workers Insurance coverage Company, and an outdoor reviewer issued a sequence of denials that concluded Eric’s advantages wouldn’t cowl histotripsy, claiming the therapy was not medically crucial. Becky Tennant estimated the process would price the household about $50,000 out-of-pocket.
Though the therapy wasn’t assured to work, it was value a shot, the Tennants thought, so that they thought of withdrawing cash from their retirement financial savings. However then, in Might, after KFF Well being Information and NBC Information posed a sequence of inquiries to UnitedHealthcare and the Public Workers Insurance coverage Company about Eric’s case, the company reversed course. PEIA determined to cowl his therapy.
Notably, the company contacted KFF Well being Information concerning the approval hours earlier than it notified the Tennant household of the choice.
However the approval got here too late. Eric was hospitalized in late Might and prescribed treatment that prevented him from present process histotripsy at the moment. His household held out hope that his well being would enhance and he would qualify for the process that summer time.
In July, they took a household trip to Marco Island, Florida. It might be their final. Two days after they returned residence, a scan revealed Eric’s most cancers had continued to unfold. Histotripsy was out of the query.
“I’m unhappy for what we are going to miss out on,” Becky mentioned. “I’m unhappy on the unfairness of it.”
She mentioned if Eric had been capable of bear histotripsy in February, as initially beneficial by his physician, it may need destroyed the tumor in his liver that finally killed him.
“We’ll by no means know. That’s the factor. Any lawyer for the insurance coverage will say, ‘Effectively, you don’t know it might have helped.’ No. You took that probability away from us,” she mentioned.
In October, Samantha Knapp, a spokesperson for the West Virginia Division of Administration, instructed KFF Well being Information that the Public Workers Insurance coverage Company has not modified its insurance policies associated to prior authorization for histotripsy and continues to comply with UnitedHealthcare’s tips.
UnitedHealthcare declined to reply questions for this text.
On Sept. 17, in a hospice mattress arrange of their eating room, Eric was surrounded by his household and their canines as he died. Becky held his hand as his coronary heart fee started to drop.
“He wasn’t afraid to die, however he didn’t wish to die,” she mentioned. “And you can inform the final day that he was combating it massive time.”
On the very finish, she whispered in his ear: “ I like you. You might have been the very best husband and the very best dad, and also you’ve all the time taken such excellent care of us,” Becky recalled.
After which, she mentioned, he gasped. His eyebrows appeared to shoot up in surprise. Throughout his final second alive, she mentioned, he smiled.
“The look on his face was pure, whole amazement,” she mentioned. “I nonetheless can’t imagine he’s not right here.”
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