Topic

Insurance Approval

A collection of 2506 issues

How to Get Cresemba (Isavuconazole) Covered by Humana in New Jersey: Renewal Guide, Forms, and Appeals Process

Answer Box: Quick Start Guide Getting Cresemba (isavuconazole) renewed with Humana in New Jersey: Submit renewal documentation 30-45 days before current authorization expires. Include updated clinical notes showing treatment response, recent liver function tests, and evidence of ongoing infection. For Medicare Advantage members, use federal appeals process (not NJ IHCAP)

Do You Qualify for Emgality Coverage by Humana in Georgia? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Most likely to get Emgality covered by Humana in Georgia if you have: 1. Documented chronic or episodic migraine (≥4 migraine days/month for 3+ months) 2. Failed at least 2 standard preventives (like topiramate, propranolol) for 6-12 weeks each 3. Age 18+ with neurologist

How to Get Brineura (Cerliponase Alfa) Covered by UnitedHealthcare in Washington: Complete Policy Guide and Appeals Process

Answer Box: Getting Brineura Covered by UnitedHealthcare in Washington UnitedHealthcare covers Brineura (cerliponase alfa) for pediatric CLN2 disease patients age 3+ under strict prior authorization requirements. Your fastest path: 1) Confirm CLN2 diagnosis with genetic testing, 2) Get pediatric neurologist to submit complete PA documentation via UHC provider portal, 3)

Myths vs. Facts: Getting HyperHEP (Hepatitis B Immune Globulin) Covered by Blue Cross Blue Shield in Virginia

Answer Box: HyperHEP Coverage by Blue Cross Blue Shield in Virginia Yes, Blue Cross Blue Shield plans in Virginia typically cover HyperHEP (hepatitis B immune globulin) with prior authorization. The fastest path to approval: document clear post-exposure prophylaxis indication with timing within 7 days of exposure, submit complete prior authorization

How to Get Enhertu (fam-trastuzumab deruxtecan-nxki) Covered by Humana in Washington: Appeals, Forms & Approval Timeline

Answer Box: Getting Enhertu Covered by Humana in Washington Fast track to approval: Enhertu requires prior authorization from Humana, typically placed on Specialty Tier 4. Your oncologist must submit HER2 testing results and clinical documentation through Humana's provider portal. If denied, you have 65 days to appeal and

How to Get Amondys 45 (Casimersen) Covered by Cigna in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Amondys 45 (Casimersen) Covered by Cigna in Pennsylvania Fastest path to approval: Submit prior authorization through Cigna's provider portal or call 1-800-882-4462 with genetic testing confirming exon 45-amenable DMD mutation, specialist prescription, and infusion plan. If denied, file internal appeal within 60 days, then Pennsylvania

Work With Your Doctor to Get Xospata (gilteritinib) Approved by Blue Cross Blue Shield in Washington

Quick Answer: Your Path to Xospata Approval To get Xospata (gilteritinib) covered by Blue Cross Blue Shield in Washington, you'll need: confirmed FLT3 mutation testing, documentation of relapsed/refractory AML status, and evidence of prior therapy failures. Start by scheduling a comprehensive visit with your hematologist to gather

Getting Raxone (Idebenone) Covered by Blue Cross Blue Shield Michigan: Complete Coding, Prior Authorization, and Appeals Guide

Answer Box: Raxone (idebenone) is not FDA-approved and won't appear on Blue Cross Blue Shield of Michigan formularies, making coverage extremely challenging. Your best path: (1) Submit a formulary exception request through the BCBSM provider portal with comprehensive LHON documentation using ICD-10 code H47.22, (2) Include genetic

How to Get Enhertu Covered by Aetna CVS Health in California: Prior Authorization Guide and Appeal Process

Answer Box: Getting Enhertu Covered by Aetna CVS Health in California Enhertu (fam-trastuzumab deruxtecan-nxki) requires prior authorization from Aetna CVS Health for HER2-positive breast cancer, NSCLC, and gastric cancer. Your fastest path to approval: 1) Gather HER2 test results and prior therapy records, 2) Submit PA request via Availity portal

Get Vanflyta (Quizartinib) Approved by Aetna CVS Health in Texas: Complete Forms & Appeals Guide

Answer Box: Get Vanflyta Covered by Aetna CVS Health in Texas Vanflyta (quizartinib) requires prior authorization from Aetna CVS Health for FLT3-ITD positive acute myeloid leukemia. Start by confirming your FLT3-ITD test results, then submit the current Aetna PA form with EKG documentation showing QTc ≤ 450ms. If denied, you have