Topic

Insurance Approval

A collection of 776 issues

How to Renew Evkeeza (Evinacumab-dgnb) Coverage with Cigna in Pennsylvania: 2025 Requirements and Timeline

Quick Answer: Cigna typically grants Evkeeza (evinacumab-dgnb) renewals for one year if you submit updated clinical documentation showing continued benefit and medical necessity. Start your renewal 60-90 days before your current authorization expires. Submit through Cigna's provider portal or Express Scripts with recent lipid panels, adherence records, and

How to Get Rapivab (Peramivir) Covered by Humana in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rapivab (Peramivir) Covered by Humana in Pennsylvania Rapivab (peramivir) requires prior authorization from Humana and is typically approved only when oral antivirals like oseltamivir (Tamiflu) can't be used due to medical contraindications. Your fastest path to approval: Have your provider submit the Humana Medicare Prescription

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

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

Get Tecentriq (Atezolizumab) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization Guide

Answer Box: Tecentriq (atezolizumab) requires prior authorization from Blue Cross Blue Shield in Virginia for all 2024 plans. Success depends on meeting FDA-approved indication criteria, proper PD-L1 testing (≥1% for adjuvant NSCLC, ≥50% for first-line metastatic), and comprehensive documentation. If denied, you have 120 days to file an external review

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

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

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by Cigna in New Jersey: Complete Appeals Guide

Answer Box: Getting Besponsa Covered by Cigna in New Jersey Besponsa (inotuzumab ozogamicin) requires prior authorization from Cigna with strict documentation of CD22-positive B-cell ALL diagnosis, hepatic monitoring plan, and prior therapy history. If denied, you have 180 days for internal appeals, then 4 months for New Jersey's

Myths vs. Facts: Getting Vimizim (Elosulfase Alfa) Covered by Humana in Washington

Quick Answer: Getting Vimizim Covered by Humana in Washington Vimizim (elosulfase alfa) requires prior authorization from Humana Medicare Advantage plans, with approval based on confirmed MPS IVA diagnosis, specialist prescriber, and detailed clinical documentation. If denied, Washington residents have strong appeal rights through Medicare's multi-level process, including external

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.