What Is a 'Gold Card'? The Rule That Skips Prior Authorization
A growing number of states let doctors with strong approval records skip prior authorization entirely. Here's how 'gold carding' works, and its limits.
Becky Tennant spent months submitting medical records, expert opinions, and appeals to a West Virginia state health plan that had denied her husband's doctor-recommended cancer treatment. By the time the insurer reversed itself, Eric Tennant was no longer considered a good candidate for the procedure. He died in September at age 58.
His case became the reason West Virginia's governor signed a law in March letting patients switch to an already-approved category of treatment without restarting the approval process from scratch. It's also a small piece of a much bigger, quieter fight playing out in state legislatures: over which doctors get to skip prior authorization altogether, through a mechanism called "gold carding."
"Families should not have to beg, appeal, or go public just to access time-sensitive care."
Becky Tennant, in testimony to West Virginia lawmakers, via KFF Health News
What Is Gold Carding, Exactly?
Gold carding exempts a provider from submitting prior authorization requests for a specific service or drug category, once that provider has racked up a high approval rate — typically 80% to 90% — over a six- to twelve-month look-back period. Earn the card, and the insurer stops requiring permission for that category for the next six to twelve months. Fall below the threshold at the next review, and the exemption disappears.
It isn't a blanket pass. A gold card applies to one provider, for one service or drug category, with one insurer. A cardiologist gold-carded for stress tests by one insurer still needs prior authorization from a different insurer, and still needs it for procedures outside that specific category.
Which States Actually Have It?
Six states had adopted gold-carding legislation before the 2025 legislative session: Arkansas, Colorado, Louisiana, Texas, West Virginia, and Wyoming, with Michigan and Vermont also enacting versions of the law. Arkansas, Texas, and West Virginia amended their existing programs in 2025 — Arkansas removed a rule letting insurers strip gold-card status if a provider's procedure volume grew by 25%, and extended the exemption to group practices; Texas stretched its look-back period from six months to a full year. The American Medical Association was tracking active gold-carding bills in 13 more states as of last year.
Why Would Insurers Agree to This?
Prior authorization exists because insurers say it curbs unnecessary or ineffective care. But a 2022 AHIP survey of 26 health plans found just over half had used gold carding for medical services, and about a fifth for prescriptions — and the results were mixed even by the industry's own accounting: 23% of plans said patient safety improved or stayed flat, while 20% said gold carding raised costs without improving quality.
That ambivalence shows up in the politics, too. In testimony against a Missouri gold-card bill, a Cigna executive argued the policy would "increase inappropriate care and costs." The St. Louis Area Business Health Coalition — whose members include Boeing and Peabody Energy — separately opposed a similar bill, arguing state-mandated exceptions remove the flexibility insurers and providers need to handle edge cases.
What Gold Carding Doesn't Fix
Gold carding only helps if your doctor already has a strong approval track record with your specific insurer — it does nothing for a new physician, a rare specialist, or anyone whose insurer hasn't rolled out a program at all. Prescription drugs are walled off from most gold-card laws entirely: West Virginia's program doesn't cover medications, and neither do Louisiana's or Wyoming's. If your denial involves a drug rather than a procedure, a gold card in your state likely won't touch it. It also doesn't override a plan's medical-necessity criteria — a gold-carded doctor can still recommend something the insurer's rules don't cover.
Does Gold Carding Actually Reduce Delays for Patients?
The honest answer: it depends on your doctor's specific track record with your specific insurer, and the evidence so far is thin and mixed. By late 2025, 49 states plus Washington, D.C. and Puerto Rico had at least one prior-authorization law on the books, according to a National Association of Insurance Commissioners report — but gold carding is only one tool among several, alongside mandatory response-time deadlines and bans on retroactive denials. Prior authorization delays became enough of a national flashpoint that nearly half of state legislatures took up some form of reform bill in 2025 alone.
How Do I Find Out If My Doctor Has One?
Ask your provider's office directly whether they hold gold-card status with your specific insurer for the procedure in question — it isn't listed anywhere publicly searchable. If your state hasn't passed gold-card legislation, the more useful question is whether it has a hard response-time requirement instead; several states now mandate insurer decisions within 24 hours for urgent requests and 48 hours for routine ones.
Becky Tennant's fight didn't run through a gold card — her husband's case became the argument for a narrower, different fix. But the throughline across both is the same: patients are increasingly the ones who have to know these programs exist, because insurers aren't required to volunteer it.
