Topic

Insurance Approval

A collection of 2429 issues

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

How to Get Galafold (Migalastat) Covered by Humana in New York: Step Therapy Rules, Appeals, and External Review

Answer Box: Getting Galafold (Migalastat) Covered by Humana in New York Fastest path to approval: Submit a formulary exception with genetic testing proving amenable GLA mutation, plus medical necessity letter from a specialist. Humana must respond within 72 hours (24 hours for urgent cases). If denied, file an external appeal

Myths vs. Facts: Getting Galafold (migalastat) Covered by Aetna (CVS Health) in New Jersey

Answer Box: Getting Galafold (migalastat) Covered by Aetna (CVS Health) in New Jersey Key Facts: Aetna requires prior authorization for Galafold with documented amenable GLA variant and specialist prescription. Most denials stem from incomplete genetic documentation or missing step therapy attempts with enzyme replacement therapy. Fastest Path to Approval: 1.

How to Get Jynarque (Tolvaptan) Covered by Cigna in Texas: Complete PA Guide and Appeals Process

Quick Answer: Getting Jynarque (Tolvaptan) Covered by Cigna in Texas Jynarque requires prior authorization from Cigna and is typically classified as Tier 4 specialty. The fastest path: (1) Enroll in Jynarque REMS program with your nephrologist, (2) Submit PA with documented ADPKD rapid progression (Mayo Class 1C-1E or eGFR decline

How to Get Qinlock (Ripretinib) Covered by Cigna in New Jersey: Timeline, Forms & Appeal Process

Answer Box: Getting Qinlock Covered by Cigna in New Jersey Cigna requires prior authorization for Qinlock (ripretinib) in New Jersey, with approval typically taking 1-3 business days once complete documentation is submitted. Under New Jersey's 2025 regulations, Cigna must respond within 2 business days for standard requests or

How to Get Cabometyx (Cabozantinib) Covered by Humana in New Jersey: Prior Authorization, Appeals, and State Protections

Answer Box: Your Fastest Path to Coverage Cabometyx (cabozantinib) requires prior authorization under Humana Medicare Advantage plans in New Jersey. The fastest path: Have your oncologist submit a PA request through Humana's provider portal with complete clinical documentation including diagnosis, prior therapies, and imaging results. If denied, you