Topic

Insurance Approval

A collection of 2704 issues

How to Get Orladeyo (Berotralstat) Covered by UnitedHealthcare in New Jersey: Complete Guide with Forms and Appeal Templates

Answer Box: Getting Orladeyo Covered by UnitedHealthcare in New Jersey Orladeyo (berotralstat) requires prior authorization from UnitedHealthcare in New Jersey. To get approved: 1. Visit an HAE specialist (allergist/immunologist) who can document your hereditary angioedema diagnosis with C1-INH testing and attack frequency 2. Submit prior authorization through the UnitedHealthcare
6 min read

How to Get Adynovate (Antihemophilic Factor) Covered by Aetna CVS Health in Illinois: Complete Prior Authorization Guide

Quick Answer: Getting Adynovate Covered by Aetna CVS Health in Illinois Adynovate requires prior authorization from Aetna CVS Health in Illinois. Submit requests through the Availity portal with complete hemophilia A documentation including Factor VIII activity levels, bleeding history, and medical necessity justification. If denied, you have 180 days to
6 min read

Getting Jaypirca (Pirtobrutinib) Approved by UnitedHealthcare in Virginia: Complete Guide to Coverage, Appeals, and Forms

Answer Box: Fast Track to Jaypirca Coverage in Virginia Getting Jaypirca (pirtobrutinib) approved by UnitedHealthcare in Virginia requires prior authorization and documentation of failed BTK inhibitor therapy. The fastest path: 1) Gather records of prior BTK inhibitor treatment (ibrutinib, acalabrutinib, or zanubrutinib) and failure/intolerance, 2) Submit complete prior authorization
5 min read

How to Get Bavencio (Avelumab) Covered by Humana in Pennsylvania: Complete Prior Authorization Guide

Answer Box: Getting Bavencio Covered by Humana in Pennsylvania Bavencio (avelumab) requires prior authorization from Humana for both Medicare Advantage and commercial plans in Pennsylvania. For fastest approval: (1) Confirm your diagnosis meets FDA indications (metastatic Merkel cell carcinoma or maintenance urothelial carcinoma), (2) Have your oncologist submit PA through
6 min read

How to Get Advate (Octocog Alfa) Covered by Blue Cross Blue Shield in Virginia: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Advate Covered in Virginia Anthem Blue Cross Blue Shield Virginia requires prior authorization for Advate (octocog alfa) using HCPCS code J7194 and ICD-10 code D66. Submit PA requests through the Availity Essentials portal with complete clinical documentation including hemophilia A diagnosis, factor VIII levels, and treatment history.
6 min read

Myths vs. Facts: Getting StrataGraft Covered by Cigna in Washington (Appeals Guide & Documentation Tips)

Answer Box: Getting StrataGraft Covered by Cigna in Washington StrataGraft requires prior authorization from Cigna and is only covered for FDA-approved deep partial-thickness thermal burns in adults. Common myths include believing all doctor prescriptions are automatically covered and that pharmacy billing is correct. Reality: You need detailed burn documentation, proper
5 min read