Topic

Insurance Approval

A collection of 2806 issues

Myths vs. Facts: Getting Helixate (antihemophilic factor, rFVIII) Covered by Aetna (CVS Health) in California

Answer Box: Helixate Coverage Through Aetna (CVS Health) in California Helixate (recombinant factor VIII) requires prior authorization from Aetna (CVS Health) and may face coverage challenges due to product discontinuation in the US. Alternative rFVIII products like Kovaltry or Jivi are typically covered with proper documentation. In California, if denied,

How to Get Juxtapid (lomitapide) Covered by UnitedHealthcare in New Jersey: Complete Guide with Forms and Appeals

Answer Box: Getting Juxtapid Covered by UnitedHealthcare in New Jersey Juxtapid (lomitapide) requires prior authorization from UnitedHealthcare for homozygous familial hypercholesterolemia (HoFH). First, confirm your diagnosis with genetic testing documentation. Submit the UnitedHealthcare prior authorization form through their provider portal, including proof you've tried other HoFH treatments first.

Getting Pyrukynd (Mitapivat) Covered by Humana in Virginia: Prior Authorization to Appeals

Quick Answer: To get Pyrukynd (mitapivat) covered by Humana in Virginia, you'll need prior authorization with genetic testing confirming pyruvate kinase deficiency, hemoglobin ≤10 g/dL, transfusion history documentation, and a hematologist's letter. If denied, you have 65 days to appeal through Humana, then 120 days

How to Get Voydeya (Danicopan) Covered by UnitedHealthcare in New York: Complete Guide to Approval and Appeals

Answer Box: Getting Voydeya Covered in New York Yes, UnitedHealthcare covers Voydeya (danicopan) in New York with prior authorization. The fastest path: 1) Confirm you're on a C5 inhibitor (eculizumab/ravulizumab), 2) Have your doctor submit PA through UnitedHealthcare's provider portal with PNH diagnosis and evidence

How to Get Synagis (Palivizumab) Covered by UnitedHealthcare in Georgia: Prior Authorization Forms, Appeals, and Timeline

Answer Box: Getting Synagis Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Synagis (palivizumab) in Georgia, with strict eligibility criteria for high-risk infants during RSV season (October-March). To get coverage: 1. Verify eligibility: Child must meet specific high-risk criteria (premature birth <29 weeks, chronic lung disease, or

Get Haegarda Covered by Humana in Illinois: Prior Authorization Guide & Appeal Process

Answer Box: Getting Haegarda Covered by Humana in Illinois Humana requires prior authorization for Haegarda (C1-esterase inhibitor, SC) with step therapy documentation showing trial of preferred HAE alternatives first. In Illinois, you have 65 days to appeal denials and 30 days for external review if internal appeals fail. Start today:

How to Get Enbrel (Etanercept) Covered by Humana in Georgia: Prior Authorization, Appeals, and Medical Necessity Requirements

Answer Box: Getting Enbrel Covered by Humana in Georgia Humana requires prior authorization and step therapy for Enbrel (etanercept) in Georgia. You must try preferred alternatives first, provide TB screening within 12 months, and document medical necessity through a specialist. If denied, you have 65 days to appeal internally, then

How to Get Increlex (Mecasermin) Covered by UnitedHealthcare in Texas: Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Increlex Covered by UnitedHealthcare in Texas Increlex (mecasermin) requires prior authorization from UnitedHealthcare and must be dispensed through specific specialty pharmacies (Accredo, BriovaRx, CVS Specialty, or Walgreens Specialty). To get approved: 1. Submit prior authorization with documented severe primary IGF-1 deficiency diagnosis, growth charts, and lab results

How to Get Qalsody (Tofersen) Covered by Aetna CVS Health in Texas: Prior Authorization, Appeals & Success Strategies

Answer Box: Getting Qalsody Covered by Aetna CVS Health in Texas Aetna CVS Health requires prior authorization for Qalsody (tofersen) and covers it only for adults with confirmed SOD1-mutation ALS. Your fastest path to approval: (1) Confirm SOD1 genetic testing results, (2) Have a neurologist submit the prior authorization with

How to Get Thiola / Thiola EC (Tiopronin) Covered by UnitedHealthcare in Florida: Complete Coding, Appeals & Approval Guide

Answer Box: Getting Thiola/Thiola EC Covered by UnitedHealthcare in Florida Thiola (tiopronin) requires prior authorization from UnitedHealthcare OptumRx for cystinuria treatment. The fastest path to approval: 1) Ensure your provider documents cystinuria diagnosis (ICD-10: E72.01) with 24-hour urine cystine levels and stone history, 2) Submit prior authorization through