Topic

Insurance Approval

A collection of 2404 issues

How to Get Xywav (Ca/Mg/K/Na oxybates) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Xywav Covered in Illinois UnitedHealthcare requires prior authorization for Xywav with step therapy requirements. Your fastest path: 1) Enroll in the mandatory REMS program, 2) Document failed trials with preferred alternatives like Xyrem, 3) Submit complete OptumRx prior authorization form with sleep study results and ICD-10 codes

How to Get Aldurazyme (Laronidase) Covered by Blue Cross Blue Shield in North Carolina: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Aldurazyme Covered by Blue Cross Blue Shield in North Carolina Aldurazyme (laronidase) requires prior authorization from Blue Cross Blue Shield of North Carolina. Success depends on documented MPS I diagnosis via enzymatic testing and genetic confirmation. If denied, you have 120 days to file an external review

How to Get Tysabri (Natalizumab) Covered by Humana in Pennsylvania: Appeals Guide with Templates

Quick Answer: Getting Tysabri Covered by Humana in Pennsylvania If Humana denied your Tysabri (natalizumab) coverage, you have options. First step: Ensure TOUCH program enrollment for both patient and prescriber—this is mandatory. Fastest path: Submit a formulary exception with medical necessity documentation showing failed DMTs and contraindications to alternatives.

How to Get Fintepla (fenfluramine) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Fintepla Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield plans in Pennsylvania require prior authorization for Fintepla (fenfluramine) with specific REMS program enrollment and cardiac monitoring documentation. The fastest path to approval involves: (1) completing REMS enrollment with baseline echocardiogram, (2) documenting diagnosis

Get Voydeya (Danicopan) Approved by UnitedHealthcare in North Carolina: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Voydeya Covered by UnitedHealthcare in North Carolina Voydeya (danicopan) requires prior authorization from UnitedHealthcare for coverage as an add-on therapy to C5 inhibitors (eculizumab or ravulizumab) in adults with paroxysmal nocturnal hemoglobinuria (PNH) experiencing extravascular hemolysis. Your fastest path to approval: Have your hematologist submit a prior

How to Get Skyrizi (Risankizumab) Covered by UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Skyrizi Covered by UnitedHealthcare in Florida Skyrizi (risankizumab) requires prior authorization from UnitedHealthcare in Florida. You'll need to document failure or intolerance to at least one TNF inhibitor (like Humira or Enbrel), provide specialty consultation notes, and submit disease severity measurements. The fastest path: have

How to Get Kalydeco (ivacaftor) Covered by Cigna in Virginia: Complete Prior Authorization Guide

Quick Answer: Getting Kalydeco (ivacaftor) Covered by Cigna in Virginia To get Kalydeco approved by Cigna in Virginia, you need: (1) documented CFTR mutation testing showing an eligible variant (not homozygous F508del), (2) cystic fibrosis diagnosis with ICD-10 code E84.0, and (3) prior authorization submission through Cigna's

Myths vs. Facts: Getting Darzalex/Darzalex Faspro Covered by Blue Cross Blue Shield in Texas

Quick Answer: Getting Darzalex/Darzalex Faspro Covered in Texas Blue Cross Blue Shield of Texas requires prior authorization for Darzalex (daratumumab) with specific documentation. Coverage depends on your multiple myeloma diagnosis, prior therapy history, and combination partners. Most denials stem from incomplete documentation or off-pathway use. First step: Have your

Work With Your Doctor to Get Retevmo (Selpercatinib) Approved by UnitedHealthcare in New York: Provider Partnership Guide

Answer Box: Getting Retevmo Covered by UnitedHealthcare in New York To get Retevmo (selpercatinib) approved by UnitedHealthcare in New York: Your oncologist must submit a prior authorization request with confirmed RET fusion testing results and clinical documentation. If denied, you have 180 days for internal appeals and 4 months for

Get Mycapssa (Octreotide Oral) Covered by Humana in New Jersey: Provider Collaboration Guide

Answer Box: Your Path to Mycapssa Coverage To get Mycapssa (oral octreotide) covered by Humana in New Jersey, you'll need prior authorization with documentation of acromegaly diagnosis and prior injectable SSA response. Your provider must submit a medical necessity letter through Humana's portal within 72 hours