Topic

Insurance Approval

A collection of 5267 issues

How to Get Elfabrio (Pegunigalsidase Alfa-iwxj) Covered by Blue Cross Blue Shield in Texas: Complete Requirements Guide

Answer Box: Getting Elfabrio Covered by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Elfabrio (pegunigalsidase alfa-iwxj) with confirmed Fabry disease diagnosis and specialist oversight. The fastest path to approval: (1) Submit PA through BCBS portal with genetic testing or enzyme deficiency results, (2) Include prescriber

Renewing Galafold (Migalastat) Coverage with UnitedHealthcare in Illinois: Timeline, Documentation, and Appeal Options

Answer Box: Renewing Galafold Coverage with UnitedHealthcare in Illinois UnitedHealthcare requires annual reauthorization for Galafold (migalastat) with documentation of positive clinical response. Submit renewal requests 30-60 days before expiration through OptumRx with specialist notes showing treatment response (reduced GL-3 levels, stable kidney function). If denied, you have 180 days for

How to Get Kanuma (Sebelipase Alfa) Covered by Humana in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kanuma Covered by Humana in Virginia Humana Medicare Advantage plans require prior authorization for Kanuma (sebelipase alfa) to treat LAL deficiency, with coverage requiring documented enzyme deficiency testing and clinical severity evidence. The fastest path: Have your prescriber submit a complete PA request through Humana's

How to Get Hetlioz (Tasimelteon) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Hetlioz Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Hetlioz (tasimelteon) with mandatory step therapy requiring a 30-day melatonin trial failure. You'll need diagnosis documentation (Non-24 sleep disorder ICD-10 G47.24 or Smith-Magenis syndrome), specialist consultation, and submission via OptumRx specialty pharmacy. First

How to Get Cresemba (Isavuconazole) Covered by Blue Cross Blue Shield in California: Prior Authorization Forms, Appeals & Timelines

Answer Box: Getting Cresemba Covered by Blue Cross Blue Shield in California Blue Cross Blue Shield California requires prior authorization for all Cresemba (isavuconazole) requests. Submit clinical documentation showing confirmed invasive aspergillosis or mucormycosis (ICD-10 codes B46.0-B46.9) via AuthAccel portal or fax. If denied, file an internal appeal

Humana's Coverage Criteria for Hemlibra (emicizumab-kxwh) in New Jersey: What Counts as "Medically Necessary"?

Answer Box: Getting Hemlibra Covered by Humana in New Jersey Hemlibra (emicizumab-kxwh) requires prior authorization from Humana Medicare plans with specific medical necessity criteria: confirmed hemophilia A diagnosis (ICD-10 D66), documented factor VIII inhibitor status (≥5 Bethesda units), bleeding history, and weight-based dosing plan. Submit through Humana's provider

Myths vs. Facts: Getting Jynarque (tolvaptan) Covered by Aetna (CVS Health) in Ohio

Answer Box: Getting Jynarque (tolvaptan) Covered by Aetna (CVS Health) in Ohio Fastest path to approval: Document rapid ADPKD progression (Mayo Classification 1C-1E or eGFR decline ≥3.0 mL/min/1.73 m²/year), complete REMS enrollment, and submit prior authorization through CVS Caremark with comprehensive clinical documentation. If denied,

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Tepezza Coverage with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Tepezza (teprotumumab) in New Jersey for moderate-to-severe thyroid eye disease. Your ophthalmologist or endocrinologist must submit documentation showing Clinical Activity Score ≥3, euthyroid status, and failed corticosteroid treatment via the UHC Provider Portal. If denied, New

How to Get Myalept (Metreleptin) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Myalept Covered by Aetna CVS Health in Virginia Myalept (metreleptin) requires prior authorization from Aetna CVS Health for generalized lipodystrophy (ICD-10 E88.12) only. The fastest path to approval: (1) Complete REMS certification at MyaleptREMS.com, (2) Submit PA with confirmed generalized lipodystrophy diagnosis, metabolic complications documentation,

How to Get Cosentyx (Secukinumab) Covered by Humana in Virginia: ICD-10 Codes, HCPCS Billing, and Appeals Guide

Answer Box: Getting Cosentyx (Secukinumab) Covered by Humana in Virginia Cosentyx (secukinumab) requires prior authorization from Humana with step therapy through preferred biologics first. The fastest path: your doctor submits a PA request via Humana's provider portal with proper ICD-10 codes (L40.0 for plaque psoriasis, L40.5x