Topic

Insurance Approval

A collection of 603 issues

How to Renew Ocrevus (Ocrelizumab) Coverage with Aetna CVS Health in Virginia: Timeline, Forms & Bridge Options

Answer Box: Renewing Ocrevus Coverage with Aetna CVS Health in Virginia To renew Ocrevus (ocrelizumab) with Aetna CVS Health in Virginia, submit your renewal request at least 2 weeks before your next scheduled infusion. You'll need updated clinical documentation showing disease stability or improvement, neurologist attestation, and confirmation

How to Get Vyondys 53 (Golodirsen) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Vyondys 53 Covered by Aetna CVS Health in Illinois Fastest path to approval: Submit prior authorization with genetic testing confirming exon 53 mutation, baseline kidney function labs, and neuromuscular specialist oversight. If denied, request peer-to-peer review within days, then file internal appeal within 180 days. Illinois residents

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Humana in North Carolina: Complete Guide to Prior Authorization, Appeals, and Billing Codes

Answer Box: Getting Besponsa Covered by Humana in North Carolina Besponsa (inotuzumab ozogamicin) requires prior authorization through Evolent/New Century Health for all Humana Medicare Advantage plans. Submit requests via their portal at my.newcenturyhealth.com or call 844-926-4528 (option 5). Required documentation includes CD22-positive B-cell ALL diagnosis (ICD-10: C91.

How to Get Mavenclad (Cladribine) Covered by Humana in North Carolina: Complete Prior Authorization Guide

Answer Box: Your Path to Mavenclad Coverage Mavenclad (cladribine tablets) requires prior authorization from Humana and is subject to step therapy requirements. In North Carolina, you have 65 days to appeal denials through Humana's internal process, then 120 days to file external review with Smart NC. First step

Work With Your Doctor to Get Luxturna (Voretigene Neparvovec-rzyl) Approved by Blue Cross Blue Shield in Ohio: Complete Provider Collaboration Guide

Answer Box: Getting Luxturna Approved in Ohio Luxturna (voretigene neparvovec-rzyl) requires prior authorization from Blue Cross Blue Shield in Ohio, with strict criteria including confirmed biallelic RPE65 mutations and viable retinal cells. The fastest path: 1) Get genetic testing confirming RPE65 mutations, 2) Schedule comprehensive retinal assessment at a qualified

Get Arcalyst (Rilonacept) Covered by Aetna CVS Health in New York: Complete Coding, Billing & Appeals Guide

Answer Box: Quick Path to Arcalyst Coverage Arcalyst (rilonacept) requires prior authorization from Aetna CVS Health for all FDA-approved indications. In New York, submit the CVS Caremark specialty PA form with diagnosis documentation (ICD-10 M04.2 for CAPS, I31.9 for recurrent pericarditis), prior therapy failures, and specialist consultation. If

How to Get Dojolvi (Triheptanoin) Covered by Humana in Georgia: Complete Coding and Appeal Guide

Answer Box: Getting Dojolvi (Triheptanoin) Covered by Humana in Georgia Dojolvi (triheptanoin) requires prior authorization from Humana Medicare Advantage, billed under NDC 69794-0050-50 with ICD-10 codes E71.310 or E71.318. Your prescriber must submit molecular genetic confirmation of long-chain fatty acid oxidation disorder (LC-FAOD) plus clinical documentation. If denied,

Do You Qualify for Hemlibra Coverage by Cigna in North Carolina? Decision Tree & Next Steps

Answer Box: Qualifying for Hemlibra Coverage by Cigna in North Carolina You likely qualify if you have confirmed hemophilia A, documented bleeding episodes, and a hematology specialist's prescription. Fastest path: Have your doctor submit prior authorization through Cigna's provider portal with diagnosis proof, inhibitor status testing,

How to Get Cabometyx (Cabozantinib) Covered by Cigna in Virginia: Complete Guide to Prior Authorization, Appeals, and State Protections

Quick Answer: To get Cabometyx (cabozantinib) covered by Cigna in Virginia, your doctor must submit a prior authorization through CoverMyMeds or ExpressPAth within 72 hours for standard review (24 hours if expedited). If denied, file an internal appeal within 180 days, then request external review through Virginia's Bureau

How to Get Signifor/Signifor LAR Covered by UnitedHealthcare in Illinois: Complete Guide to Prior Authorization, Appeals & Forms

Quick Answer: Getting Signifor/Signifor LAR Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Signifor (pasireotide) in Illinois. For Cushing's disease: coverage is approved when pituitary surgery isn't an option or hasn't been curative—no step therapy required. For acromegaly: you must