Topic

Insurance Approval

A collection of 2560 issues

Get Defitelio (Defibrotide) Covered by UnitedHealthcare in Georgia: Decision Tree & Appeal Guide

Answer Box: Quick Path to Defitelio Coverage Do you qualify for Defitelio (defibrotide) coverage by UnitedHealthcare in Georgia? If you have hepatic veno-occlusive disease (VOD) with renal or pulmonary dysfunction after stem cell transplant, likely yes—but prior authorization is required. Fastest path: 1) Confirm diagnosis meets FDA criteria, 2)

Getting Sylvant (Siltuximab) Covered by Humana in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Sylvant Coverage To get Sylvant (siltuximab) covered by Humana in New York: Submit prior authorization through Humana's provider portal with HIV-negative and HHV-8-negative lab results, confirmed multicentric Castleman disease diagnosis, and oncologist consultation. If denied, file internal appeal within 65 days, then use

How Long Does It Take to Get Idelvion Approved by Blue Cross Blue Shield in California? Timeline & Appeal Guide

Answer Box: Getting Idelvion Covered by Blue Cross Blue Shield in California Timeline: Standard prior authorization takes 5-7 business days; expedited requests process within 24-48 hours. Fastest path: Submit complete documentation through Blue Shield's online portal with lab results showing factor IX deficiency, bleeding history, and medical necessity

How to Get Cosentyx (Secukinumab) Covered by UnitedHealthcare in North Carolina: Appeals Guide & Success Strategies

Answer Box: Getting Cosentyx Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Cosentyx (secukinumab) with specific documentation of treatment failures and medical necessity. The fastest path: Have your dermatologist or rheumatologist submit a complete PA request with detailed records of failed first-line therapies. If denied, you have

How to Get Xospata (gilteritinib) Covered by Aetna (CVS Health) in Virginia: Complete Timeline and Appeal Guide

Answer Box: Getting Xospata (gilteritinib) Covered by Aetna (CVS Health) in Virginia Aetna (CVS Health) requires prior authorization for Xospata (gilteritinib) in Virginia. You'll need: confirmed FLT3 mutation via FDA-approved test, relapsed/refractory AML diagnosis, complete prior therapy history, and hematologist/oncologist prescription. Submit through Aetna's

How to Get Entresto (sacubitril/valsartan) Covered by Blue Cross Blue Shield in Virginia: PA Forms, Appeal Scripts & State Protections

Quick Answer: Getting Entresto Covered in Virginia Entresto (sacubitril/valsartan) is covered by Blue Cross Blue Shield Virginia (Anthem) but requires prior authorization. Your fastest path to approval: (1) Have your doctor submit a PA request with heart failure diagnosis, ejection fraction data, and documentation of ACE inhibitor trial/failure,

Getting Enbrel (Etanercept) Covered by UnitedHealthcare in New York: A Real Patient Journey From Denial to Approval

Answer Box: Getting Enbrel Covered by UnitedHealthcare in New York Fastest path to approval: Submit prior authorization through UnitedHealthcare's provider portal with specialist prescription, documented DMARD failure, negative TB screening, and medical necessity letter. If denied, file internal appeal within 180 days, then external review through NY Department

How to Get Ultomiris (Ravulizumab) Approved by UnitedHealthcare in New York: Timeline, Requirements & Appeals

Quick Answer: Getting Ultomiris Approved by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Ultomiris (ravulizumab) with standard review taking up to 7 calendar days, expedited requests within 2 business days. Starting January 1, 2025, new patients may face step therapy requirements through OptumRx. If denied, New York residents

How to Get Humate-P Covered by UnitedHealthcare in Illinois: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Humate-P Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Humate-P (antihemophilic factor/von Willebrand factor complex) and typically enforces step therapy requiring trial of desmopressin (DDAVP) first, unless contraindicated. If denied, you have 30 days for internal appeals and up to 4 months for Illinois

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Blue Cross Blue Shield in New York: Prior Authorization, Appeals, and Documentation Guide

Answer Box: Getting Orkambi Covered by BCBS in New York Orkambi requires prior authorization from Blue Cross Blue Shield plans in New York. Key requirement: documented F508del homozygous mutation with specialist prescription. Fastest path: Have your CF specialist submit PA through the BCBS provider portal with genetic testing, clinical notes,