Topic

Insurance Approval

A collection of 6354 issues

How to Get Entresto (sacubitril/valsartan) Covered by Aetna (CVS Health) in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Entresto Covered by Aetna (CVS Health) in North Carolina Aetna (CVS Health) requires prior authorization for Entresto (sacubitril/valsartan) in heart failure with reduced ejection fraction (LVEF ≤40%). Submit complete documentation through the Aetna provider portal or fax 1-859-425-3379 within 14 days for approval. If denied, appeal

Get Crysvita (Burosumab) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Crysvita Covered by UnitedHealthcare in North Carolina Yes, UnitedHealthcare covers Crysvita (burosumab) for X-linked hypophosphatemia (XLH) and tumor-induced osteomalacia (TIO), but requires prior authorization through specialty providers. Your endocrinologist submits the PA via UnitedHealthcare's provider portal with genetic testing results, lab values, and treatment history.

How to Get Dojolvi (Triheptanoin) Covered by UnitedHealthcare in Texas: Complete PA Guide with Appeal Scripts

Answer Box: Getting Dojolvi Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of LC-FAOD via genetic testing or enzyme activity. In Texas, you have strong appeal rights including expedited external review through Independent Review Organizations. First step today: Contact your board-certified medical geneticist

How to Get Joenja (leniolisib) Covered by Blue Cross Blue Shield of North Carolina: Complete Appeals Guide

Answer Box: Quick Path to Coverage To get Joenja (leniolisib) covered by Blue Cross Blue Shield of North Carolina (BCBSNC): 1) Confirm APDS diagnosis with genetic testing via navigateAPDS.com (free), 2) Submit prior authorization through BCBSNC's specialty pharmacy network with medical necessity documentation, 3) If denied, file

How to Get Kuvan (Sapropterin Dihydrochloride) Covered by Cigna in New York: Complete Timeline and Appeals Guide

Answer Box: Getting Kuvan Covered by Cigna in New York Cigna requires prior authorization for Kuvan (sapropterin dihydrochloride) prescribed by a PKU specialist, with documented BH4 responsiveness (≥20-30% phenylalanine reduction) and concurrent low-phenylalanine diet. Standard approval takes 1-5 days via electronic submission through CoverMyMeds or Cigna's portal. If

How to Get Cometriq (cabozantinib) Covered by UnitedHealthcare in Michigan: Complete PA Guide with Forms and Appeals

Getting Cometriq (cabozantinib) covered by UnitedHealthcare in Michigan requires prior authorization for metastatic medullary thyroid carcinoma (MTC) or progressive thyroid cancers after failed step therapy. Submit via the UHC Provider Portal with diagnosis confirmation, or call 866-889-8054. If denied, you have 180 days for internal appeals and 127 days for

How to Get Isturisa (Osilodrostat) Covered by Aetna (CVS Health) in Virginia: Complete Guide with Forms, Appeals, and Timelines

Quick Answer: Getting Isturisa (Osilodrostat) Approved by Aetna (CVS Health) in Virginia Aetna requires prior authorization for Isturisa (osilodrostat) in adults with confirmed Cushing's disease when surgery has failed or is contraindicated. Submit the specialty PA form via Aetna's provider portal or fax to 1-877-269-9916 with

Do You Qualify for Bylvay (odevixibat) Coverage by Blue Cross Blue Shield in Virginia? Decision Tree & Next Steps

Answer Box: To get Bylvay (odevixibat) covered by Blue Cross Blue Shield in Virginia, you need: (1) confirmed PFIC or Alagille syndrome diagnosis from a GI specialist, (2) age 3+ months for PFIC or 12+ months for Alagille, and (3) documentation of symptom severity. Submit prior authorization through your doctor&

Do You Qualify for Ocrevus (Ocrelizumab) Coverage by Cigna in New York? Complete Decision Tree & Appeals Guide

Answer Box: Ocrevus Coverage by Cigna in New York Yes, you likely qualify if you have confirmed relapsing or primary progressive MS and have tried/failed at least one disease-modifying therapy. Cigna requires prior authorization through CoverMyMeds or fax (855-840-1678) with 5-day processing. First step today: Contact your neurologist to

Requirements Checklist to Get Qinlock (ripretinib) Covered by Aetna CVS Health in Virginia

Answer Box: Getting Qinlock (ripretinib) Covered by Aetna CVS Health in Virginia Eligibility: Qinlock requires prior authorization from Aetna CVS Health for fourth-line GIST treatment after documented failure of imatinib, sunitinib, and regorafenib. Fastest path: Submit complete documentation including pathology report, treatment history with outcomes, and medical necessity letter through