Topic

Insurance Approval

A collection of 5287 issues

The Requirements Checklist to Get Advate (octocog alfa) Covered by UnitedHealthcare in Illinois: Complete PA and Appeal Guide

Answer Box: Getting Advate Covered by UnitedHealthcare in Illinois Advate (octocog alfa) requires prior authorization through UnitedHealthcare's OptumRx with step therapy requirements favoring preferred Factor VIII products. The fastest path to approval: 1) Submit complete PA with hemophilia A diagnosis (ICD-10: D66), inhibitor-negative status, and bleeding history via
5 min read

How to Get Ocrevus (Ocrelizumab) Covered by UnitedHealthcare in Florida: Complete Guide with Forms, Appeals, and Timelines

Answer Box: Getting Ocrevus Covered by UnitedHealthcare in Florida Yes, UnitedHealthcare covers Ocrevus (ocrelizumab) for multiple sclerosis, but requires prior authorization with specific documentation. Your neurologist submits the PA request through the UHC Provider Portal or by fax to 866-940-7328, including MS diagnosis confirmation, hepatitis B screening results, and evidence
6 min read

How to Get Elevidys Gene Therapy Covered by Aetna CVS Health in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Started To get Elevidys (delandistrogene moxeparvovec-rokl) covered by Aetna CVS Health in New York: Submit prior authorization through the Availity portal with genetic confirmation, ambulatory status documentation, and approved infusion center verification. If denied, file internal appeal within 180 days, then New York external appeal within 4
6 min read

How to Get Cabometyx (Cabozantinib) Covered by UnitedHealthcare in Washington: Complete PA Guide with ICD-10 Codes and Appeals

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization (PA) for Cabometyx (cabozantinib tablets) through OptumRx for all FDA-approved cancer indications in Washington. Submit PA with confirmed diagnosis (ICD-10: C64 for RCC, C22.0 for HCC), prior therapy documentation, and RECIST imaging showing progression. If denied,
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Get Rylaze (Asparaginase Erwinia Chrysanthemi) Covered by Humana in Ohio: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Getting Rylaze Covered by Humana in Ohio Humana requires prior authorization for Rylaze (asparaginase erwinia chrysanthemi recombinant-rywn) for ALL/LBL patients with documented Grade 2-4 hypersensitivity to E. coli-derived asparaginase. Your oncologist submits the PA request via Humana's provider portal with hypersensitivity documentation, diagnosis codes, and
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Getting Mycapssa (Octreotide Oral) Approved by UnitedHealthcare in Georgia: Prior Authorization Guide and Appeals Process

Answer Box: How to Get Mycapssa Approved by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Mycapssa (oral octreotide) with step therapy mandating prior response to injectable octreotide or lanreotide. Submit your PA through OptumRx with acromegaly diagnosis (E22.0), documented injectable response, and medical necessity letter. If denied, you
5 min read