Topic

Insurance Approval

A collection of 711 issues

How to Get Tysabri (Natalizumab) Covered by UnitedHealthcare in Michigan: Appeals, Copay Programs & Prior Authorization

Quick Answer: Getting Tysabri Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Tysabri (natalizumab) through their Provider Portal or by calling 888-397-8129. If denied, you have internal appeal rights followed by Michigan DIFS external review within 127 days. First step today: Have your doctor submit a prior authorization

How Long Does It Take to Get Signifor LAR (Pasireotide) Approved by Humana in New York? Timeline & Appeal Process

Answer Box: Getting Signifor LAR Covered by Humana in New York Timeline: Humana Medicare Advantage must decide on Signifor LAR (pasireotide) prior authorization within 7 calendar days (standard) or 72 hours (expedited) starting January 2026. Currently, most electronic submissions get responses within one business day. Fastest path: Submit complete documentation

How to Get Synagis (Palivizumab) Covered by Aetna CVS Health in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Synagis Covered by Aetna CVS Health in New York Aetna CVS Health requires prior authorization for Synagis (palivizumab) and only covers it when Beyfortus is contraindicated, not tolerated, or ineffective. Your child must meet strict high-risk criteria: premature infants <29 weeks and <12 months old,

How to Get Natpara Covered by Blue Cross Blue Shield in North Carolina: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Natpara Covered by Blue Cross Blue Shield in North Carolina Important Update: Natpara manufacturing ended December 2024, with the Special Use Program ceasing December 31, 2025. New patient requests are typically denied due to discontinued availability. For existing patients transitioning off Natpara, focus on documenting medical necessity

How to Get Naglazyme (Galsulfase) Covered by Blue Cross Blue Shield in Illinois: Prior Authorization, Appeals, and State Rights

Answer Box: Your Fastest Path to Approval Getting Naglazyme (galsulfase) covered by Blue Cross Blue Shield of Illinois requires prior authorization with confirmed MPS VI diagnosis and specialist oversight. Illinois law prohibits step therapy for formulary drugs (effective January 2025), but standard PA still applies. If denied, you have 60

Myths vs. Facts: Getting Evkeeza (evinacumab-dgnb) Covered by Aetna (CVS Health) in North Carolina

Answer Box: Fast Track to Evkeeza Coverage Getting Evkeeza (evinacumab-dgnb) covered by Aetna (CVS Health) in North Carolina requires prior authorization and documented failure of standard therapies. The fastest path: ensure your doctor submits comprehensive documentation of HoFH diagnosis, failed statin/ezetimibe/PCSK9 inhibitor trials, and current LDL-C levels via

Getting Hetlioz LQ (Tasimelteon) Covered by Cigna in Michigan: Complete PA Guide and Appeals Process

Answer Box: How to Get Hetlioz LQ Covered by Cigna in Michigan Fastest path to approval: Submit prior authorization with confirmed Smith-Magenis Syndrome genetic testing, documented melatonin failure, and weight-based dosing rationale. If denied, file internal appeal within 180 days, then external review with Michigan DIFS within 127 days. Start

How to Get Mycapssa (Octreotide Oral) Covered by Cigna in Texas: PA Forms, Appeals & Success Tips

Answer Box: Getting Mycapssa Covered by Cigna in Texas Mycapssa (oral octreotide) requires prior authorization from Cigna with specific documentation: acromegaly diagnosis, prior response to injectable octreotide/lanreotide for 3+ months, and endocrinologist prescription. Fastest path: Have your endocrinologist submit PA with baseline IGF-1 labs, treatment history, and medical necessity

How to Get Rapivab (Peramivir) Covered by Aetna CVS Health in Pennsylvania: Appeals Guide & Templates

Quick Answer: Getting Rapivab Covered by Aetna CVS Health in Pennsylvania Rapivab (peramivir) requires prior authorization from Aetna CVS Health and is covered on their 2024 Medicare formulary in Pennsylvania. If denied, you have strong appeal rights: complete Aetna's internal appeal within 180 days, then use Pennsylvania'

Xospata (Gilteritinib) Approval with UnitedHealthcare in Virginia: Answers to the Most Common Questions

Answer Box: Getting Xospata Covered by UnitedHealthcare in Virginia Xospata (gilteritinib) requires prior authorization from UnitedHealthcare for relapsed/refractory AML with confirmed FLT3 mutations. Fastest approval path: Submit PA with FDA-approved FLT3 test results, prior therapy documentation, and oncologist's medical necessity letter. First step today: Have your hematologist/