It didn’t matter that Eric Tennant’s oncologist had really useful the medicine to shrink his tumors.
The affected person’s medical health insurance allegedly stood in the way in which — till it was too late.
In early 2025, after greater than two years of chemotherapy that hollowed him out from the within, the frail 58-year-old was deemed a very good candidate for histotripsy, a brand new remedy that would goal the tumors in his liver with ultrasound waves as a substitute of surgical procedure.
Tennant’s spouse, Rebecca, had heard of histotripsy and introduced the thought to her husband’s physician. There was a comparatively slender window through which he might obtain the remedy, and his medical group was prepared to start out.
However immediately Tennant’s docs have been handicapped: His insurance coverage had denied the request, noting within the paperwork that the possibly life-saving remedy was “not medically mandatory,” per NBC Information and KFF Well being Information.
A number of rounds of appeals have been unsuccessful. Out-of-pocket prices for the Tennant household — which included Eric, his spouse and their two grown kids — would have been round $50,000.
Tennant, a mining security teacher from Bridgeport, West Virginia, was placed on hospice final yr and died in September.
“He wasn’t afraid to die, however he didn’t wish to die,” Rebecca advised KFF. “And you may inform the final day that he was combating it large time.”
Tennant had been identified with stage 4 cholangiocarcinoma, a uncommon most cancers that attacked his bile ducts earlier than spreading to different components of his physique. By the point Rebecca found histotripsy, his largest tumor was in his liver.
It was unlikely that the proposed remedy would have despatched Tennant into full remission, however the household believed it might have purchased him some extra time.
This tragic flip of occasions shouldn’t be unusual.
Prior authorization — a bureaucratic headache for sufferers, their households and their docs — is a broadly unpopular quirk of the healthcare system that may maintain sick individuals languishing with out correct remedy indefinitely.
In response to a latest report from KFF, delaying or denying care in some circumstances truly drives earnings for medical health insurance firms.
The well being information outlet added that greater than 1 / 4 of US physicians surveyed by the American Medical Affiliation in December mentioned “prior authorization had led to a critical hostile occasion for a affected person of their care.”
And eight% of respondents mentioned prior authorization “led to a incapacity, delivery defect or demise.”
The principle justification for prior authorization is that it “acts as a guardrail” in opposition to the irresponsible administration of sure medicines, a spokesperson for a medical health insurance trade commerce group advised KFF.
However for households just like the Tennants, the one final result is heartbreak.
Per KFF, the late Tennant was insured by the Public Workers Insurance coverage Company of West Virginia, which companions with UnitedHealthcare. (The Publish reached out to each companies for remark.)
Early final yr, when these two companies and an outdoor reviewer deemed histotripsy was not medically mandatory for Eric and denied protection, the household briefly thought of tapping their retirement financial savings to cowl the out-of-pocket value.
However a number of months later — notably after KFF and NBC Information contacted the medical health insurance companies with questions concerning the denial — the choice was reversed.
At that time, nonetheless, it was too late. Eric’s situation had worsened, and he was now not a candidate for histotripsy.
Final fall, after her husband’s demise, Rebecca advised KFF that if he had undergone histotripsy when his physician ordered it, the deadly tumor in his liver might need been neutralized.
However nobody can say for certain.
“We’ll by no means know. That’s the factor,” the widow mentioned on the time. “Any lawyer for the insurance coverage will say, ‘Effectively, you don’t know it could have helped.’ No. You took that probability away from us.”
