Topic

Insurance Approval

A collection of 2578 issues

How to Get Procysbi (Cysteamine Bitartrate DR) Covered by Blue Cross Blue Shield in Georgia: Complete Appeals Guide

Answer Box: Getting Procysbi Covered by Blue Cross Blue Shield in Georgia Blue Cross Blue Shield of Georgia requires prior authorization for Procysbi (cysteamine bitartrate DR) for nephropathic cystinosis. The fastest path: (1) Submit PA with complete cystinosis diagnosis documentation and WBC cystine levels, (2) Include step therapy justification if

How to Get Defitelio (defibrotide) Covered by Blue Cross Blue Shield in Ohio: Appeals Guide & Templates

Answer Box: Getting Defitelio (defibrotide) Covered by Blue Cross Blue Shield in Ohio Defitelio requires prior authorization from Blue Cross Blue Shield in Ohio for hepatic veno-occlusive disease (VOD) with renal or pulmonary dysfunction post-stem cell transplant. The fastest path to approval: 1) Have your transplant specialist submit a complete

Get Acthar Gel Covered by Humana in Georgia: Prior Authorization Guide, Appeal Forms, and Medical Necessity Tips

Quick Answer: Getting Acthar Gel Covered by Humana in Georgia Acthar Gel requires prior authorization from Humana with strict step therapy requirements. For most conditions except infantile spasms, you must try Purified Cortrophin Gel first unless contraindicated. Your doctor needs to document corticosteroid failure or intolerance. If denied, Georgia residents

Do You Qualify for Zokinvy (Lonafarnib) Coverage by Humana in Illinois? Complete Decision Tree & Appeal Guide

Answer Box: Your Path to Zokinvy Coverage Can you get Zokinvy (lonafarnib) covered by Humana in Illinois? Yes, if you have confirmed HGPS or processing-deficient progeroid laminopathy with genetic testing, are ≥12 months old with BSA ≥0.39 m², and work with a specialist. Fastest approval path: 1) Confirm genetic

Work With Your Doctor to Get Haegarda Approved by Aetna CVS Health in North Carolina: Forms, Appeals, and Scripts

Answer Box: Fastest Path to Haegarda Coverage To get Haegarda (C1-esterase inhibitor, SC) covered by Aetna CVS Health in North Carolina: Your doctor must submit a prior authorization with lab-confirmed HAE diagnosis (low C4, abnormal C1-INH levels), specialist consultation, and medical necessity documentation. If denied, you have 180 days for

How to Get Mycapssa (Octreotide Oral) Covered by Blue Cross Blue Shield in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Mycapssa Coverage Mycapssa (oral octreotide) requires prior authorization from Blue Cross Blue Shield Ohio. You must be 18+, have confirmed acromegaly, and have previously responded to injectable octreotide or lanreotide. Your endocrinologist submits the PA request with proof of prior injectable response and current IGF-1

How Long Does It Take to Get Sumavel DosePro (Sumatriptan Injection) Approved by Aetna CVS Health in Illinois? Complete Timeline Guide

Answer Box: Getting Sumavel DosePro Approved by Aetna CVS Health in Illinois Important Note: Sumavel DosePro (needle-free sumatriptan injection) was discontinued by the manufacturer in the U.S., though needle-based auto-injectors remain available. For current sumatriptan injection options, Aetna CVS Health typically requires 30-45 days for standard prior authorization decisions

How to Get Cometriq (Cabozantinib) Covered by Blue Cross Blue Shield Michigan: Complete Guide to Prior Authorization, Appeals, and Coding

Answer Box: Getting Cometriq Covered by BCBS Michigan Cometriq (cabozantinib) is covered by Blue Cross Blue Shield of Michigan with prior authorization for metastatic medullary thyroid carcinoma. Key requirements: ICD-10 code C73, documented MTC diagnosis, and electronic PA submission via CoverMyMeds or similar platform. If denied, you have 127 days

How to Get Rinvoq (Upadacitinib) Covered by UnitedHealthcare in Florida: Prior Auth, Appeals & Cost Assistance

Quick Answer: Getting Rinvoq Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Rinvoq (upadacitinib) with mandatory step therapy—you must first try and fail at least one TNF inhibitor before approval. In Florida, if denied, you have 180 days to file an internal appeal, followed by external review

Blue Cross Blue Shield New York Humira Coverage: Complete Guide to Prior Authorization, Appeals, and Medical Necessity Requirements

Answer Box: Getting Humira Covered by BCBS New York Blue Cross Blue Shield New York requires prior authorization for Humira (adalimumab), with step therapy to biosimilars increasingly required in 2025. Success depends on complete medical necessity documentation including TB/HBV screening, prior therapy failures, and diagnosis-specific criteria. Fastest path to