Wyoming doctors can now skip insurance approvals — here’s what that means for your care

New law cuts red tape for doctors

Starting Jan. 1, 2026, some Wyoming doctors can skip the insurance approval process for certain medical services.

The change comes from House Bill 14, the Ensuring Transparency in Prior Authorization Act, which lawmakers passed during the 2024 session.

The gold carding provision is just one part of a bigger overhaul of how health insurers handle treatment approvals in the state.

Before this law took effect, Wyoming was the only state in the country with no rules governing prior authorization.

Doctors spend 13 hours a week on paperwork

Prior authorization means a doctor has to get the OK from an insurance company before certain treatments, tests, or procedures are covered. Insurers say it helps control costs and prevents unnecessary care.

Doctors see it differently. A 2024 American Medical Association survey found that 93% of doctors said the process delays patient care.

On average, doctors and their staff spend about 13 hours a week filling out that paperwork. More than three-quarters of doctors said patients sometimes give up on treatment entirely because of the hassle.

Doctors must hit a 90% approval rate

The gold card works for one specific service at a time, not as a blanket pass.

To qualify, a doctor must have sent at least five prior authorization requests for that service over the previous 12 months. At least 90% of those requests must have gotten approved.

If both boxes are checked, the doctor can skip prior authorization for that service for a full year. The insurer has to let the doctor know they’ve qualified.

Prescriptions and some plans are excluded

The gold card does not cover pharmacy or prescription drugs. It only applies to state-regulated health insurers doing business in Wyoming.

Self-insured employer plans, which fall under federal law and cover a big share of working Americans, are not affected. And the exemption is tied to each doctor and each specific service.

A whole medical practice does not earn it just because one of its doctors qualifies.

Insurers review gold cards every year

Insurers check each doctor’s approval rate every 12 months.

If a doctor’s rate for a gold-carded service drops below 90% during that review, the insurer can pull the exemption.

Doctors who lose their gold card status go back to submitting prior authorization requests the regular way. New doctors and new services get added or removed from the program after each annual review cycle.

UnitedHealthcare has published details about how that review process works in Wyoming.

The law also helps opioid and rehab patients

House Bill 14 does more than gold carding. It removes prior authorization requirements for medications that treat opioid use disorder.

Patients who switch insurance plans now get at least 90 days of continued access to treatments and medications their old plan already approved.

People seeking rehab services like physical therapy or occupational therapy no longer need prior authorization, either.

And when an insurer denies a claim, a licensed health care provider familiar with the patient’s history must now make that call.

Lawmakers raised the bar during debate

The original bill set the gold card threshold at 80%.

Lawmakers bumped it up to 90% during committee work in 2024 after hearing from both medical groups and insurance companies.

The Wyoming Medical Society spent several months working with the legislature’s Labor, Health and Social Services Committee to shape the final version.

Lawmakers also decided to cut prescription drugs from gold card eligibility during that same process.

About 10 states now have gold card laws

Wyoming joins a growing club. At least 10 states now have gold card laws, including Texas, Arkansas, Colorado, Louisiana, Illinois, Michigan, New Mexico, Vermont, and West Virginia.

Each state writes its own rules for approval thresholds, review periods, and which services qualify. Approval rate thresholds range from 80% to as high as 95% to 100%, depending on the state.

Exemption periods typically last six to 12 months.

Texas passed its law first but few doctors qualified

Texas was the first state to pass a gold card law back in 2021. But the results have been modest.

Only about 3% of Texas providers have earned gold card status, according to state insurance regulators.

Texas revised its law in 2025 to extend the review period from six months to one year and widen the pool of claims that count.

Wyoming’s law already uses a 12-month evaluation window, which could help more doctors qualify from the start.

Most Americans say insurance delays are a big problem

A 2025 KFF poll found that 73% of Americans consider insurance delays and denials a major problem. Among insured adults who needed specialized care, more than a third said their insurance delayed or denied treatment.

Nearly half of the people who went through prior authorization called it somewhat or very difficult.

The health care industry spent about $1.3 billion on prior authorization administrative costs in one recent year, a 30% jump from the year before.

Federal rules tighten timelines in 2026 too

Wyoming is not acting alone. The Centers for Medicare and Medicaid Services finalized new rules in 2024 for Medicare Advantage and Medicaid plans.

Starting in 2026, those plans must issue urgent prior authorization decisions within 72 hours and standard ones within seven days. By 2027, most must have automated electronic systems in place.

In June 2025, several major insurers made a voluntary pledge to cut prior authorization burdens, though those commitments carry no enforcement power.

Real impact depends on how many doctors qualify

For patients whose doctors earn a gold card, treatment approvals for those services should come faster with less paperwork.

People switching plans now get 90 days of guaranteed coverage for treatments their old insurer already approved. Those seeking rehab or opioid treatment face fewer hurdles.

But the law’s real test in Wyoming comes after the first review cycle ends in December 2026.

Patients on self-insured employer plans or federal programs like Medicare Advantage will not see changes from this state law.

This article was created with AI assistance and human editing.

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