Topic

Insurance Approval

A collection of 795 issues

How to Get Krystexxa (Pegloticase) Covered by Aetna CVS Health in Pennsylvania: Complete Coding, Appeals & Timeline Guide

Answer Box: Your Fastest Path to Krystexxa Coverage To get Krystexxa (pegloticase) covered by Aetna CVS Health in Pennsylvania: Submit a prior authorization with ICD-10 code M1A.*** (chronic gout), HCPCS J2507 (8 units per dose), documented failure of allopurinol and febuxostat, G6PD test results, and methotrexate co-therapy plan. If denied,

How to Get Rylaze Approved by Cigna in Pennsylvania: Prior Authorization Forms, Appeal Process, and Medical Necessity Requirements

Answer Box: Getting Rylaze Covered by Cigna in Pennsylvania Rylaze (asparaginase erwinia chrysanthemi [recombinant]-rywn) requires prior authorization from Cigna in Pennsylvania. The fastest path to approval: submit Cigna's Rylaze PA form with documented E. coli asparaginase hypersensitivity, ALL/LBL diagnosis, and oncologist prescription. Standard approval takes 72

Getting Ozempic and Mounjaro Covered by Aetna CVS Health in Texas: Complete Prior Authorization Guide

Answer Box: How to Get Ozempic or Mounjaro Covered by Aetna CVS Health in Texas Both Ozempic (semaglutide) and Mounjaro (tirzepatide) require prior authorization from Aetna CVS Health in Texas. The fastest path to approval: 1) Have your doctor submit a prior authorization request with documented metformin failure and proper

Do You Qualify for Xyrem Coverage by Humana in Pennsylvania? Decision Tree & Next Steps

Answer Box: Getting Xyrem Covered by Humana in Pennsylvania You likely qualify if you have confirmed narcolepsy with cataplexy (ICD-10: G47.411), documented sleep study results, and have tried/failed standard therapies. First step: Your prescriber must enroll in the REMS program and submit prior authorization to Humana with clinical

Getting Takhzyro (Lanadelumab) Covered by Humana in Illinois: Complete Coverage Guide with Forms and Appeal Process

Answer Box: Your Fastest Path to Takhzyro Coverage Takhzyro (lanadelumab-flyo) requires prior authorization from Humana in Illinois. You'll need confirmed HAE Type I/II diagnosis (low C4 and C1-INH levels), documented attack frequency, and proof of failure/contraindication to Haegarda or similar prophylaxis. Start today by: (1) gathering

Resources to Get Humate-P Covered by Blue Cross Blue Shield in Florida: Forms, Portals & Appeals

Answer Box: Quick Start Guide Blue Cross Blue Shield Florida (Florida Blue) requires prior authorization for Humate-P for von Willebrand disease and hemophilia A treatment. The fastest path to approval: (1) Have your prescribing physician submit the prior authorization request via the Florida Blue provider portal or call 1-877-719-2583, (2)

How to Get Venclexta (venetoclax) Covered by UnitedHealthcare in California: Prior Authorization Guide & Appeal Scripts

Quick Answer: Getting Venclexta Covered by UnitedHealthcare in California Venclexta (venetoclax) requires prior authorization from UnitedHealthcare for CLL, AML, and other approved blood cancers. The fastest path: Your oncologist submits PA documentation showing your diagnosis, tumor lysis syndrome monitoring plan, and any required prior therapies. If denied, California's

How to Get HyperHEP B Covered by Cigna in Pennsylvania: Prior Authorization Guide and Appeal Process

Quick Answer: Getting HyperHEP B Covered by Cigna in Pennsylvania HyperHEP B (hepatitis B immune globulin) requires prior authorization from Cigna for post-exposure prophylaxis. The fastest path to approval: 1) Document the specific exposure event and timing (within 24 hours preferred, up to 7 days), 2) Submit through Cigna'

How to Get Opdivo (Nivolumab) Covered by Cigna in Georgia: Complete Guide to Prior Authorization and Appeals

Answer Box: Quick Path to Opdivo Coverage Opdivo (nivolumab) requires prior authorization from Cigna in Georgia. Your oncologist must submit clinical documentation proving medical necessity through Cigna's provider portal or CoverMyMeds. If denied, you have 180 days to file an internal appeal, then up to 4 months for

Work With Your Doctor to Get Lutathera (Lutetium Lu-177 Dotatate) Approved by Blue Cross Blue Shield in New Jersey

Getting Lutathera Covered: Your Path to Approval Lutathera (lutetium Lu-177 dotatate) requires prior authorization from Blue Cross Blue Shield in New Jersey. Success depends on documenting somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs), progression on first-line somatostatin analog therapy, and meeting specific medical necessity criteria. The fastest path: work closely with