For nearly three years, Eric Tennant endured chemotherapy infusions, radiation treatments, biopsies and hospitalizations that left him weak and exhausted.
“It’s good to be home,” he said after one hospital stay in early June, “but I’m tired and ready to do my own thing.”
In 2023, Tennant, of Bridgeport, West Virginia, was diagnosed with cholangiocarcinoma, a rare cancer of the bile ducts that had spread throughout his body.
None of the initial treatments prescribed by his doctors were able to eradicate the cancer. But a glimmer of hope came in early 2025 when Tennant was recommended for histotripsy, a relatively new procedure that would use ultrasound waves to target and potentially destroy the largest tumor in his body, his liver.
“My dad was a little nervous because it was something new, but it definitely gave us some hope that he would stick around a little longer,” said Tennant's daughter, Amiya.
There was just one catch: his insurance company wouldn't pay for it.
Tennant, 58, died of cancer on September 17. His story illustrates how the bureaucratic process was called prior authorization. can be devastating to patients and their families.
It is impossible to count the people affected by this. extremely unpopular practicewhich, by delaying or denying medical care, helps increase the profits of health insurers. No government agency or private group tracks such data.
However, in recent years, KFF Health News has heard from hundreds of patients who say they or someone in their family was harmed by prior authorization. More than 1 in 4 doctors American Medical Association survey in December said the prior authorization resulted in serious adverse consequences for a patient under their care. And 8% said prior authorization resulted in disability, birth defect or death.
In June, the Trump administration announced bailsigned by dozens of private insurers to streamline prior authorization, which often requires patients or their health care teams to seek approval from insurers before proceeding with many types of care. It remains unclear when patients can expect improvement.
The commitments are “dependent on the full cooperation of the private insurance sector” and “will take time to achieve full effect,” said Andrew Nixon, a spokesman for the Department of Health and Human Services. But he said there was an obligation to “prevent tragic deaths like Eric's at the hands of an ineffective system.”
Chris Bond, a spokesman for AHIP, a health insurance industry trade group, said he couldn't speak to any specific insurer's prior authorization policies. Overall, however, he said prior authorization “acts as a guardrail” to ensure that drugs and treatments are not used inappropriately.
At the same time, he said, insurers recognize that patients can be disappointed when they are denied doctor-recommended care. That's why “there is a concerted effort across the industry to make this process simpler, faster and easier for patients and providers,” Bond said.
Meanwhile, this process continues to take its toll on people like Eric Tennant, whose serious diagnoses often require expensive medical services.
“Eric is gone,” said his widow, Becky. “He won't come back.”
Tennant worked as a safety instructor for the West Virginia Mine Safety and Training Administration and was covered by the state's Government Employees Insurance Agency, which contracts with UnitedHealthcare to administer benefits for state employees and their spouses and dependents.
In February and March, UnitedHealthcare, the Government Employees Insurance Agency, and a third-party reviewer issued a series of rebuttals concluding that Eric's benefits did not cover histotripsy, arguing that the treatment was not medically necessary. Becky Tennant estimates the procedure will cost the family about $50,000.
Although treatment was not guaranteed, it was worth it, the Tennants thought, so they decided to withdraw money from their retirement savings. But then, in May, after KFF Health News and NBC News asked UnitedHealthcare and the State Employees' Insurance Agency a series of questions about Eric's case, the agency changed course. PEIA decided to cover his treatment.
Notably, the agency contacted KFF Health News with approval hours before notifying Tennant's family of the decision.
But the approval came too late. Eric was hospitalized at the end of May and prescribed medications that prevented him from undergoing histotripsy at that time. His family hoped his health would improve so he could have the procedure this summer.
In July, they took a family trip to Marco Island in Florida. This will be their last time. Two days after they returned home, a scan revealed that Eric's cancer had continued to spread. Histotripsy was out of the question.
“I’m sad about what we’re going to miss out on,” Becky said. “I feel sad about the injustice of it.”
She said if Eric had been able to undergo histotripsy in February, as his doctor initially recommended, it could have destroyed the tumor in his liver that ultimately killed him.
“We will never know. That's the point. Any insurance lawyer will say, “Well, you don’t know that would help.” No. You took this chance away from us,” she said.
In October, Samantha Knapp, a spokeswoman for the West Virginia Department of Administration, told KFF Health News that the State Employees Insurance Agency has not changed its policy on prior authorization for histotripsy and continues to follow UnitedHealthcare guidelines.
UnitedHealthcare declined to answer questions for this article.
On September 17, in a hospice bed set up in their dining room, Eric died surrounded by his family and dogs. Becky held his hand as his pulse began to drop.
“He wasn't afraid to die, but he didn't want to die,” she said. “And on the last day you could tell he had been fighting this for a very long time.”
At the very end, she whispered in his ear: “You know I love you. You were the best husband and the best father, and you always took such good care of us,” Becky recalled.
And then, she said, he gasped. His eyebrows seemed to shoot up in surprise. According to her, at the last moment of his life he smiled.
“The look on his face was pure, absolute amazement,” she said. “I still can’t believe he’s not here.”
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