Topic

Insurance Approval

A collection of 6353 issues

How to Get Elaprase (Idursulfase) Covered by Humana in Georgia: Prior Authorization Guide with Appeal Scripts

Answer Box: Getting Elaprase (Idursulfase) Covered by Humana in Georgia Humana requires prior authorization for Elaprase (idursulfase), a specialty enzyme replacement therapy for Hunter syndrome (MPS II). To get approval in Georgia: 1. Confirm diagnosis with enzymatic testing (reduced iduronate-2-sulfatase activity) or genetic testing 2. Submit PA request via Humana

Getting Arikayce (Amikacin Liposome Inhalation) Covered by Blue Cross Blue Shield in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Fast Track to Arikayce Coverage in New Jersey Arikayce (amikacin liposome inhalation) requires prior authorization from Horizon Blue Cross Blue Shield of New Jersey for refractory MAC lung disease. To get approved: (1) Submit PA request with 6+ months of failed standard MAC therapy documentation, (2) Include positive

How to Get Firdapse (amifampridine) Covered by Blue Cross Blue Shield in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Firdapse Covered by Blue Cross Blue Shield in Washington Firdapse (amifampridine) requires prior authorization from Blue Cross Blue Shield plans in Washington for Lambert-Eaton myasthenic syndrome (LEMS). To get approval: (1) Ensure confirmed LEMS diagnosis with EMG and anti-VGCC antibodies by a neuromuscular specialist, (2) Submit PA

How to Get Nourianz (Istradefylline) Covered by Blue Cross Blue Shield of Texas: Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Nourianz Covered in Texas Blue Cross Blue Shield of Texas requires prior authorization for Nourianz (istradefylline), typically with step therapy requirements. Submit your PA request through Availity or call the number on your ID card. If denied, you have 180 days to file an internal appeal, followed

How to Get Stelara (ustekinumab) Covered by Aetna (CVS Health) in California: Prior Authorization, Appeals, and Alternative Options

Quick Answer: Getting Stelara Covered by Aetna in California Aetna (CVS Health) requires prior authorization for Stelara (ustekinumab) with step therapy requirements varying by indication. In California, you have strong appeal rights through the Department of Managed Health Care (DMHC) if denied. First step: Call Aetna at 1-888-632-3862 to confirm

How to Get Tavalisse (Fostamatinib) Covered by Aetna CVS Health in Washington: Forms, Appeals & Contact Guide

Quick Answer: Getting Tavalisse Covered by Aetna CVS Health in Washington Aetna CVS Health requires prior authorization for Tavalisse (fostamatinib) in Washington, with standard criteria including prior failures of corticosteroids, IVIG, and TPO agonists. Submit PA requests via your provider portal or fax to CVS Specialty at 1-800-323-2445. If denied,

How Long Does It Take to Get Mycapssa (Octreotide, Oral) Approved by Blue Cross Blue Shield in Florida? Complete Timeline Guide

Answer Box: Getting Mycapssa Approved by Florida Blue Cross Blue Shield Florida Blue Cross Blue Shield (Florida Blue) requires prior authorization for Mycapssa (oral octreotide) with standard approval taking 7-30 days and expedited review in 24-72 hours. You'll need documented acromegaly diagnosis, prior injectable somatostatin analog trial (octreotide

How to Get Zolgensma (onasemnogene abeparvovec) Covered by Humana in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by Humana in Washington Zolgensma requires prior authorization from all Humana plans, with approval based on genetic confirmation of SMN1 mutation, age under 24 months, and negative AAV9 antibodies. Submit your request through Humana's provider portal with complete documentation. If denied, you have

Blue Cross Blue Shield Pennsylvania Coverage for Vimizim (Elosulfase Alfa): Prior Authorization Requirements and Appeals Process

Quick Answer: To get Vimizim (elosulfase alfa) covered by Blue Cross Blue Shield in Pennsylvania, you need prior authorization with confirmed MPS IVA diagnosis via enzyme testing, specialist prescription, and baseline functional measures like the 6-minute walk test. If denied, Pennsylvania's new external review process overturns 50% of

How to Get Xembify (Immune Globulin, SC) Covered by Humana in Virginia: Prior Authorization Guide and Appeal Process

Answer Box: Getting Xembify Covered by Humana in Virginia Yes, Xembify (immune globulin, SC) can be covered by Humana in Virginia, but requires prior authorization. Humana lists Xembify on their prior authorization requirements for Virginia plans under billing code J1558. Fastest path to approval: 1. Confirm primary immunodeficiency diagnosis with