Topic

Insurance Approval

A collection of 3066 issues

Renewing Ruconest (C1 Esterase Inhibitor) Approval with Humana in Texas: Complete Guide to Documentation and Timelines

Answer Box: Renewing Ruconest with Humana in Texas Start your renewal 30 days before expiration. Humana requires updated clinical documentation showing ongoing medical necessity for hereditary angioedema (HAE), including attack frequency reduction and treatment response. Submit via Humana's provider portal with prescriber attestation, recent clinical notes, and evidence
6 min read

How to Get Amondys 45 (Casimersen) Covered by Aetna CVS Health in North Carolina: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Amondys 45 Covered by Aetna CVS Health in North Carolina Aetna CVS Health requires prior authorization for Amondys 45 (casimersen) with strict documentation: genetic testing confirming exon 45-amenable DMD mutation, age under 14, specialist prescription, and detailed monitoring plan. If denied, North Carolina residents can appeal internally
6 min read

How Long Does It Take to Get Cresemba (Isavuconazole) Approved by Blue Cross Blue Shield in Pennsylvania? Complete Timeline & Appeals Guide

Answer Box: Quick Start Guide Getting Cresemba (isavuconazole) approved by Blue Cross Blue Shield in Pennsylvania typically takes 5-15 business days for standard prior authorization, or 72 hours for expedited urgent requests. Your fastest path: Have your infectious disease specialist submit a complete prior authorization through the BCBS provider portal
6 min read

How to Get Skyrizi (Risankizumab) Covered by Cigna in North Carolina: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Skyrizi (risankizumab) covered by Cigna in North Carolina requires prior authorization through Express Scripts/Accredo. Submit via CoverMyMeds portal with clinical documentation showing disease severity (PASI ≥10 or BSA ≥10% for psoriasis) and prior systemic therapy failures. If denied, appeal through Cigna's internal process, then
6 min read

Work With Your Doctor to Get Somatuline Depot (Lanreotide) Approved by Blue Cross Blue Shield in Michigan: Forms, Appeals, and Success Strategies

Answer Box: Getting Somatuline Depot Covered in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Somatuline Depot (lanreotide). Approval depends on FDA-approved diagnosis (acromegaly, neuroendocrine tumors, carcinoid syndrome), documented failure of octreotide, and complete clinical documentation. First step: Have your endocrinologist or oncologist gather your treatment history
6 min read

How to Get Xospata (gilteritinib) Covered by UnitedHealthcare in Michigan: Forms, Appeals & Step-by-Step Guide

Answer Box: Getting Xospata Approved by UnitedHealthcare in Michigan Xospata (gilteritinib) requires prior authorization through OptumRx for UnitedHealthcare members in Michigan. Your oncologist must submit clinical documentation proving FLT3-mutated relapsed/refractory AML diagnosis, prior therapy history, and medical necessity via the UnitedHealthcare Provider Portal or by calling 1-800-711-4555. If denied,
6 min read