Topic

Insurance Approval

A collection of 739 issues

How to Get Prolastin-C Covered by UnitedHealthcare in Ohio: Appeals Guide with Forms and Timelines

Answer Box: Getting Prolastin-C Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Prolastin-C (alpha1-proteinase inhibitor), with approvals typically requiring severe AAT deficiency genotype (Pi*ZZ), documented emphysema, and specific lung function criteria. If denied, you have 21 calendar days to appeal through the UnitedHealthcare Provider Portal, followed by

How to Get Uptravi (Selexipag) Covered by Blue Cross Blue Shield in California: Complete Requirements Guide

Answer Box: Getting Uptravi Covered by Blue Cross Blue Shield California Uptravi (selexipag) requires prior authorization from Blue Cross Blue Shield of California for WHO Group I pulmonary arterial hypertension. To get approved: (1) Submit clinical documentation proving PAH diagnosis with right heart catheterization data, (2) Include 6-minute walk test

Resources to Get Givlaari (givosiran) Approved with Cigna in New Jersey: Complete Forms, Appeals, and Contact Guide

Answer Box: Getting Givlaari (givosiran) Covered by Cigna in New Jersey To get Givlaari approved by Cigna in New Jersey: 1. Verify coverage through your myCigna account - most plans require Accredo specialty pharmacy 2. Submit prior authorization via CoverMyMeds or fax with specialist consultation notes, attack documentation, and elevated

How to Get Spinraza (nusinersen) Covered by Blue Cross Blue Shield of Texas: Prior Authorization, Appeals & Success Strategies

Answer Box: Getting Spinraza Covered by BCBS Texas Spinraza (nusinersen) requires prior authorization from Blue Cross Blue Shield of Texas before coverage begins. The fastest path to approval involves three key steps: 1) Have your neurologist submit comprehensive medical documentation through the Availity Portal, including genetic SMA confirmation and baseline

How to Get Tecentriq (Atezolizumab) Covered by Blue Cross Blue Shield Florida: Forms, Appeals & Timeline

Answer Box: Fastest Path to Tecentriq Coverage in Florida Florida Blue Cross Blue Shield requires prior authorization for Tecentriq (atezolizumab) as a Tier 4 specialty drug. Here's your fastest path to approval: 1. Confirm your diagnosis matches FDA-approved indications (NSCLC, SCLC, HCC, melanoma, sarcoma) 2. Get PD-L1 testing

How to Get Kineret (anakinra) Covered by UnitedHealthcare in Virginia: Complete Appeals Guide with Forms and Templates

Answer Box: Getting Kineret Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Kineret (anakinra) with step therapy requirements. For rheumatoid arthritis, you must have failed at least one DMARD like methotrexate. If denied, you have 180 days for internal appeals and 120 days for Virginia's external

Get Photrexa (Riboflavin) Covered by Humana in Virginia: Prior Authorization Guide

Quick Answer: Getting Photrexa Covered by Humana in Virginia Humana requires prior authorization for Photrexa (riboflavin) corneal crosslinking procedures. Your ophthalmologist must submit documentation proving progressive keratoconus with objective measurements (Kmax increase ≥1.0 diopter, pachymetry decrease ≥15 microns over 12 months). If denied, Virginia's Bureau of Insurance

How to Get Stelara (Ustekinumab) Covered by Cigna in Texas: Appeals Guide with Forms and Timelines

Quick Answer: Getting Stelara Covered by Cigna in Texas Step 1: Your doctor submits prior authorization to Cigna (required for all Stelara prescriptions). Step 2: If denied, request a peer-to-peer review within 180 days. Step 3: File internal appeal with medical necessity letter and supporting documents. Step 4: If still

How to Get Eylea and Lucentis Covered by UnitedHealthcare in Texas: Prior Authorization Forms, Appeals, and Step Therapy Guide

Answer Box: Getting Started in Texas UnitedHealthcare requires prior authorization for both Eylea (aflibercept) and Lucentis (ranibizumab) in Texas, with step therapy typically requiring bevacizumab first unless contraindicated. Both drugs are placed in Tier 4 (Specialty) with higher copays or coinsurance. Fastest approval path: (1) Have your retina specialist submit

How to Get Onpattro (patisiran) Covered by Blue Cross Blue Shield in Florida: Complete Guide with Forms and Appeal Templates

Answer Box: Getting Onpattro Covered in Florida Eligibility: Blue Cross Blue Shield Florida covers Onpattro (patisiran) for hereditary transthyretin-mediated amyloidosis (hATTR) with polyneuropathy in adults 18+ with confirmed TTR gene mutation and specialist evaluation. Fastest path: Gather genetic testing, neurologist consultation, and baseline scores (mNIS+7, 6MWT) before submitting prior