Topic

Insurance Approval

A collection of 2730 issues

UnitedHealthcare's Coverage Criteria for Keytruda in Washington: What Counts as "Medically Necessary"?

Answer Box: Getting Keytruda Covered by UnitedHealthcare in Washington To get Keytruda (pembrolizumab) covered by UnitedHealthcare in Washington, you need prior authorization with specific biomarker testing results (PD-L1 CPS ≥1, MSI-H, or TMB-H ≥10 mutations/megabase for most indications). Submit through the UnitedHealthcare Provider Portal with complete pathology reports, clinical

How to Get Rezlidhia (Olutasidenib) Covered by Cigna in Georgia: Appeals, Forms, and Timeline Guide

Quick Answer: Getting Rezlidhia Covered by Cigna in Georgia Cigna requires prior authorization for Rezlidhia (olutasidenib) with strict criteria: patient must be 18+, have relapsed/refractory AML, and documented IDH1 mutation via FDA-approved test. If denied, you have 180 days to appeal internally, then can request Georgia's external

How to Get Breyanzi Covered by UnitedHealthcare in California: Complete Prior Authorization Guide

Quick Answer: Getting Breyanzi Approved by UnitedHealthcare in California Breyanzi (lisocabtagene maraleucel) requires prior authorization from UnitedHealthcare before administration. To get approval: (1) Submit a complete PA request through the UnitedHealthcare Provider Portal with diagnosis documentation, prior therapy records, and REMS facility certification; (2) Allow 72 hours for standard review

How to Get Elevidys Gene Therapy Covered by Florida Blue Cross Blue Shield: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Elevidys Covered in Florida Elevidys requires prior authorization from Florida Blue Cross Blue Shield with strict eligibility criteria: genetic DMD confirmation, ages 4-5 years, negative anti-AAV antibodies, and treatment at certified centers like Nicklaus Children's Hospital. The fastest path: 1) Gather genetic testing and clinical

Getting Rapivab (Peramivir) Covered by Humana in New York: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Rapivab (Peramivir) Covered by Humana in New York Rapivab (peramivir) requires prior authorization from Humana Medicare Advantage plans in New York. Submit requests using HCPCS code J2547, proper ICD-10 codes (J09-J11 series), and documentation showing symptom onset within 48 hours plus inability to use oral antivirals. First

Myths vs. Facts: Getting Opsumit (Macitentan) Covered by UnitedHealthcare in Ohio

Answer Box: Getting Opsumit Covered by UnitedHealthcare in Ohio Eligibility: UnitedHealthcare requires prior authorization for Opsumit (macitentan) with documented PAH diagnosis, WHO functional class II-IV, and specialist involvement. Fastest path: Submit comprehensive PA request through UnitedHealthcare Provider Portal with complete clinical documentation. First step today: Gather PAH diagnosis confirmation, functional

Do You Qualify for Uplizna Coverage by Blue Cross Blue Shield in Pennsylvania? Decision Tree & Next Steps

Answer Box: Your Path to Uplizna Coverage Most likely eligible if: You have confirmed AQP4-positive NMOSD or IgG4-related disease, negative hepatitis B screening, and a neurologist's prescription. First step: Contact your Blue Cross plan to request prior authorization forms—Highmark members use their provider portal, Independence Blue Cross

How to Get Hemlibra (emicizumab-kxwh) Covered by Cigna in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Hemlibra (emicizumab-kxwh) Covered by Cigna in New Jersey Hemlibra (emicizumab-kxwh) requires prior authorization from Cigna and is typically covered as a Tier 4 specialty drug for hemophilia A patients. To get approval in New Jersey: 1. Submit PA request through Cigna's provider portal with complete

How to Get Translarna (Ataluren) Covered by Aetna CVS Health in Virginia: Complete Timeline and Appeals Guide

Answer Box: Getting Translarna Covered by Aetna CVS Health in Virginia Important: Translarna (ataluren) is not FDA-approved in the United States as of 2025. However, if you're seeking coverage through expanded access or clinical trials, here's the fastest path: 1. Confirm genetic testing shows nonsense mutation

How to Get Bavencio (Avelumab) Covered by Blue Cross Blue Shield in Virginia: Complete Appeals Guide 2025

Answer Box: Getting Bavencio Covered in Virginia Bavencio (avelumab) is covered by Blue Cross Blue Shield in Virginia but requires prior authorization. The fastest path to approval: 1) Your oncologist submits prior authorization with complete clinical documentation to Anthem BCBS Virginia, 2) Include diagnosis confirmation, prior treatment history, and medical