Topic

Insurance Approval

A collection of 2380 issues

How to Get Tremfya (guselkumab) Covered by Cigna in North Carolina: Renewal Guide, Appeals, and Timeline

Answer Box: Renewing Tremfya (guselkumab) with Cigna in North Carolina Cigna requires documented clinical benefit after 6+ months of Tremfya use for renewal authorization, typically approved for 12 months. Submit renewal requests 30-60 days before expiration with objective disease measures (PASI score for psoriasis, joint counts for psoriatic arthritis) and

How to Get Dupixent Covered by UnitedHealthcare in Florida: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Dupixent Covered by UnitedHealthcare in Florida Fastest path to approval: UnitedHealthcare requires prior authorization for Dupixent through OptumRx, with specific step therapy requirements varying by indication. For atopic dermatitis, avoid concurrent biologics/JAK inhibitors. For asthma, document eosinophilic phenotype (≥150 cells/μL) or oral steroid dependence plus

Renewing iLink® Corneal Cross-Linking Approval with UnitedHealthcare in Florida: Complete Timeline & Documentation Guide

Answer Box: Renewing iLink® Coverage with UnitedHealthcare in Florida UnitedHealthcare requires prior authorization renewal for iLink® corneal cross-linking treatments in Florida, typically needed every 6-12 months or after completing initial treatment phases. Submit renewal requests at least 10 business days before your next scheduled procedure through the UHC Provider Portal.

How to Get Abecma (Idecabtagene Vicleucel) Covered by Blue Cross Blue Shield in Georgia: Appeals, Forms, and State Protections

Quick Answer: Getting Abecma Covered in Georgia Abecma requires prior authorization from Blue Cross Blue Shield in Georgia and must be delivered at an approved Center of Medical Excellence. Your fastest path: 1) Confirm your treatment facility is BCBS-approved for CAR-T therapy, 2) Have your oncologist submit prior authorization with

Get Elelyso (Taliglucerase Alfa) Covered by Aetna CVS Health in Georgia: Complete Prior Authorization Guide

Quick Answer: Aetna CVS Health requires prior authorization for Elelyso (taliglucerase alfa) with confirmed Type 1 Gaucher disease diagnosis, specialist prescriber, and documentation of medical necessity. Submit PA requests through CVS Caremark (phone: 1-800-294-5979). If denied, you have 180 days to file an internal appeal and 60 days for external

How to Get Imbruvica (Ibrutinib) Covered by Humana in Ohio: Decision Tree, Appeals, and Step-by-Step Guide

Answer Box: Your Fastest Path to Imbruvica Coverage Humana requires prior authorization for Imbruvica (ibrutinib) in Ohio. Most approvals succeed when you submit complete documentation showing FDA-approved diagnosis (CLL, SLL, or Waldenström macroglobulinemia), previous therapy failures, and medical necessity. If denied, you have 65 days to appeal through Humana'

How to Get Dojolvi (Triheptanoin) Covered by Blue Cross Blue Shield in Illinois: Complete PA and Appeal Guide

Answer Box: Getting Dojolvi Covered by BCBS Illinois Blue Cross Blue Shield Illinois requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of LC-FAOD. The fastest path: (1) Gather genetic test results showing pathogenic variants in CPT2, ACADVL, HADHA, or HADHB genes, (2) Have a metabolic specialist complete the PA

Getting Strimvelis Gene Therapy Covered by Humana in California: Complete Requirements Checklist and Appeals Guide

Answer Box: Fast Track to Coverage Strimvelis is not FDA-approved in the U.S. and only available at SR-TIGET in Milan, Italy. Humana Medicare doesn't cover international medical tourism or non-emergency overseas treatments. However, you can still pursue coverage through these steps: 1. Submit a prior authorization request

How to Get Ozempic and Mounjaro Covered by Cigna in Texas: 2025 Prior Authorization Guide

Answer Box: Quick Path to Approval Getting Cigna coverage for Ozempic or Mounjaro in Texas requires prior authorization for Type 2 diabetes only—not weight loss. Your fastest path: 1) Confirm your diagnosis is documented as Type 2 diabetes with recent A1C, 2) Have your doctor submit PA electronically via

Myths vs. Facts: Getting Vanflyta (quizartinib) Covered by Cigna in Virginia

Quick Answer: To get Vanflyta (quizartinib) covered by Cigna in Virginia, you need documented FLT3-ITD positive AML, age ≥18, and evidence you've tried preferred alternatives like midostaurin first. If denied, Virginia's external review process through the State Corporation Commission gives you a second chance—with 60-76%