Topic

Insurance Approval

A collection of 5292 issues

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,
6 min read

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
5 min read

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

How to Get Waylivra (volanesorsen) Covered by Humana in Illinois: Complete Guide with Forms, Appeals, and Assistance Programs

Answer Box: Getting Waylivra (volanesorsen) Covered by Humana in Illinois Waylivra (volanesorsen) requires prior authorization through Humana's formulary exception process since it's not FDA-approved in the US. Success depends on genetic confirmation of familial chylomicronemia syndrome (FCS), triglyceride levels >500 mg/dL despite standard therapies,
7 min read

How to Get Kymriah (tisagenlecleucel) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kymriah Covered by UnitedHealthcare in Virginia UnitedHealthcare covers Kymriah (tisagenlecleucel) under medical benefits as autologous stem cell therapy, requiring prior authorization through OptumHealth Transplant Solutions. For B-cell ALL (≤25 years) or relapsed/refractory DLBCL after ≥2 therapy lines, submit via the UHC Provider Portal with CD19+ confirmation,
6 min read