Topic

Insurance Approval

A collection of 758 issues

How to Get Photrexa (Riboflavin) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Photrexa Covered by Aetna CVS Health in Ohio Aetna CVS Health covers epithelium-off corneal cross-linking with Photrexa for progressive keratoconus and ectasia. The fastest path to approval: 1) Verify your plan covers CPT code 0402T, 2) Submit prior authorization with documented keratoconus progression (serial topography, Kmax increases)

How to Get Ibrance (Palbociclib) Covered by Humana in Florida: Complete Decision Tree and Appeals Guide

Answer Box: Getting Ibrance (Palbociclib) Covered by Humana in Florida You'll likely qualify if you have HR+/HER2- advanced breast cancer with proper pathology documentation. Humana requires prior authorization for Ibrance, typically processed within 2-3 business days with complete documentation. Your first step today: Gather your pathology reports

How to Get Kanuma (Sebelipase Alfa) Covered by Aetna (CVS Health) in Ohio: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Kanuma Covered by Aetna in Ohio Kanuma (sebelipase alfa) requires prior authorization from Aetna (CVS Health) for LAL-D patients. The fastest path: your doctor submits a prior authorization request through Aetna's Availity portal with LAL enzyme activity test results, genetic confirmation, and documented hepatic/lipid

How to Get Eloctate Covered by Humana in Texas: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Eloctate Covered by Humana in Texas Eloctate (efmoroctocog alfa) requires prior authorization from Humana in Texas for all plan types. The fastest path: Have your hematologist submit a PA request with complete clinical documentation via Humana's provider portal or fax to 877-486-2621. Include diagnosis, factor

How to Get Revlimid (Lenalidomide) Covered by UnitedHealthcare in California: A Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Revlimid Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Revlimid (lenalidomide) through OptumRx, with strict clinical criteria and REMS compliance. The fastest path to approval: (1) Ensure your oncologist submits a complete prior authorization with lab values, diagnosis codes, and treatment history through the UnitedHealthcare

Myths vs. Facts: Getting Koselugo (Selumetinib) Covered by Blue Cross Blue Shield in Michigan - Appeals Guide 2025

Answer Box: Getting Koselugo Covered in Michigan Eligibility: Blue Cross Blue Shield of Michigan covers Koselugo for pediatric patients (ages 2-18) with NF1 and symptomatic, inoperable plexiform neurofibromas requiring prior authorization. Fastest Path: Submit complete PA with baseline LVEF (echocardiogram), ophthalmologic exam, NF1 diagnosis confirmation, and tumor imaging showing inoperability.

If Keytruda Isn't Approved by Blue Cross Blue Shield in Texas: Formulary Alternatives & Exception Paths

Quick Answer: If Blue Cross Blue Shield of Texas denies Keytruda (pembrolizumab), formulary alternatives include Opdivo (nivolumab), Tecentriq (atezolizumab), Imfinzi (durvalumab), and Libtayo (cemiplimab). Submit a Prescription Drug Coverage Exception form with detailed medical documentation showing why preferred drugs failed or are contraindicated. Internal appeals have 72-hour decisions, with external

How to Get Gamifant (Emapalumab-lzsg) Covered by Humana in Virginia: Complete Guide with Forms and Appeal Process

Quick Answer: Getting Gamifant (Emapalumab-lzsg) Covered by Humana in Virginia Fastest path to approval: Have your hematologist submit a prior authorization request to Humana with documented HLH-2004 criteria (5 of 8 required), genetic testing or family history, and evidence of conventional therapy failure. Submit via fax to 502-508-9300 with complete

How to Get Qalsody (Tofersen) Covered by Humana in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Qalsody (Tofersen) Covered by Humana in Georgia Eligibility: Qalsody requires confirmed ALS with documented SOD1 mutation, neurologist prescriber, and baseline ALSFRS-R/vital capacity testing. Fastest approval path: Submit complete prior authorization with genetic testing results, clinical notes, and baseline assessments through Humana's provider portal or

How to Get Keytruda (Pembrolizumab) Covered by Blue Cross Blue Shield in Ohio: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Keytruda Covered in Ohio Keytruda (pembrolizumab) requires prior authorization from Blue Cross Blue Shield in Ohio. The fastest path to approval involves three steps: 1) Gather biomarker test results (PD-L1, MSI-H, or TMB-H as required by your cancer type), 2) Submit complete prior authorization through your provider&