Topic

Insurance Approval

A collection of 2161 issues

How to Get Cometriq (Cabozantinib) Covered by Blue Cross Blue Shield Michigan: Complete Guide to Prior Authorization, Appeals, and Coding

Answer Box: Getting Cometriq Covered by BCBS Michigan Cometriq (cabozantinib) is covered by Blue Cross Blue Shield of Michigan with prior authorization for metastatic medullary thyroid carcinoma. Key requirements: ICD-10 code C73, documented MTC diagnosis, and electronic PA submission via CoverMyMeds or similar platform. If denied, you have 127 days

How to Get Rinvoq (Upadacitinib) Covered by UnitedHealthcare in Florida: Prior Auth, Appeals & Cost Assistance

Quick Answer: Getting Rinvoq Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Rinvoq (upadacitinib) with mandatory step therapy—you must first try and fail at least one TNF inhibitor before approval. In Florida, if denied, you have 180 days to file an internal appeal, followed by external review

Blue Cross Blue Shield New York Humira Coverage: Complete Guide to Prior Authorization, Appeals, and Medical Necessity Requirements

Answer Box: Getting Humira Covered by BCBS New York Blue Cross Blue Shield New York requires prior authorization for Humira (adalimumab), with step therapy to biosimilars increasingly required in 2025. Success depends on complete medical necessity documentation including TB/HBV screening, prior therapy failures, and diagnosis-specific criteria. Fastest path to

How to Get Hetlioz (Tasimelteon) Covered by UnitedHealthcare in Washington: PA Forms, Appeals, and Cost Guide

Answer Box: Getting Hetlioz Approved by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Hetlioz (tasimelteon) with mandatory melatonin step therapy and specialty pharmacy dispensing through OptumRx. Coverage is limited to FDA-approved indications: Non-24-hour sleep-wake disorder in totally blind adults and Smith-Magenis syndrome sleep disturbances. Fastest approval path: 1) Get

How to Get Acthar Gel Covered by Humana in Texas: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Acthar Gel Covered by Humana in Texas Fastest path to approval: Humana requires prior authorization for Acthar Gel based on specific medical criteria, including documented failure or intolerance to corticosteroids. For infantile spasms (West syndrome), approval is typically straightforward with proper diagnosis. For MS exacerbations and other

Get Ozempic and Mounjaro Covered by Cigna in Georgia: PA Requirements, Step Therapy Overrides, and Appeal Guide

Answer Box: Quick Path to Coverage Getting Ozempic or Mounjaro covered by Cigna in Georgia requires prior authorization and typically step therapy with metformin first. The fastest path: Have your doctor submit clinical documentation showing metformin failure/intolerance through Cigna's ePA portal. If denied, you have 180 days

Getting Kineret (Anakinra) Covered by Humana in New York: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Quick Path to Approval Kineret (anakinra) requires prior authorization from Humana in New York. Your fastest path: 1) Have your rheumatologist submit a PA request with documentation of failed DMARDs/biologics and infection screening, 2) If denied, file an internal appeal within 65 days, 3) For urgent needs,

How to Get Emgality Covered by UnitedHealthcare in Texas: Complete Prior Authorization Guide

Answer Box: Getting Emgality Approved by UnitedHealthcare in Texas Fastest path to approval: Document failure of at least two preventive medications (like topiramate and propranolol) for 2+ months each, then submit prior authorization through the UnitedHealthcare Provider Portal. First step today: Verify your plan's formulary tier for Emgality

How to Renew Keppra (Levetiracetam) Coverage with Aetna CVS Health in Illinois: Timeline, Documentation, and Lapse Prevention

Answer Box: Renewing Keppra Coverage with Aetna CVS Health in Illinois To renew Keppra (levetiracetam) coverage with Aetna CVS Health in Illinois, submit your renewal request at least two weeks before your current authorization expires. Your neurologist must provide updated seizure frequency documentation, current clinical notes, and evidence of ongoing

How to Get Amvuttra (Vutrisiran) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Quick Answer: Getting Amvuttra Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Amvuttra (vutrisiran) with specific criteria: confirmed hATTR amyloidosis with genetic testing, specialist prescription, and stage documentation. Submit through OptumRx with complete clinical records. If denied, Virginia offers external review through the State Corporation Commission within 120