Topic

Insurance Approval

A collection of 845 issues

Myths vs. Facts: Getting Epidiolex (Cannabidiol) Covered by Humana in Texas

Answer Box: Getting Epidiolex Covered by Humana in Texas Myth: "If denied, you can't get Epidiolex." Fact: Humana requires prior authorization for Epidiolex in Texas, but denials are often overturned with proper documentation. Success requires: (1) confirmed diagnosis of LGS, Dravet syndrome, or TSC, (2) documented

How to Get Cometriq (Cabozantinib) Covered by Humana in Illinois: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Cometriq (Cabozantinib) Covered by Humana in Illinois Cometriq requires prior authorization from Humana for medullary thyroid carcinoma (MTC). The fastest path: Your oncologist submits clinical documentation with ICD-10 code C73, pathology confirming MTC, and prior treatment history to Humana's provider portal or fax 877-486-2621. If

How to Get Raxone (Idebenone) Covered by UnitedHealthcare in Pennsylvania: Prior Authorization, Appeals & Cost-Saving Strategies

Quick Answer: Raxone (idebenone) is not FDA-approved in the U.S., making UnitedHealthcare coverage extremely difficult. However, you can pursue coverage through: (1) Prior authorization with medical necessity documentation for off-label use, (2) Step therapy exceptions if alternatives failed, and (3) Pennsylvania's external review process, which overturns ~50%

How to Get Ibrance (palbociclib) Covered by Aetna CVS Health in California: Complete Prior Authorization and Appeals Guide

Quick Answer: To get Ibrance (palbociclib) covered by Aetna CVS Health in California, you need prior authorization showing HR-positive, HER2-negative advanced breast cancer diagnosis with proper documentation. Submit through CVS Specialty Pharmacy (1-866-814-5506) with pathology reports and ICD-10 codes C50.- and Z17.411. If denied, file internal appeal within

UnitedHealthcare's Coverage Criteria for Ocrevus in New Jersey: What Counts as "Medically Necessary"?

Answer Box: Getting Ocrevus Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Ocrevus (ocrelizumab) in New Jersey, with specific medical necessity criteria for both relapsing and primary progressive MS. The fastest path to approval: ensure you have a confirmed MS diagnosis, document any failed prior therapies, and

How to Get Firazyr (Icatibant) Covered by Aetna CVS Health in North Carolina: Appeals, Forms & Cost-Saving Tips

Answer Box: Getting Firazyr Covered by Aetna CVS Health in North Carolina Firazyr (icatibant) requires prior authorization from Aetna CVS Health and is excluded from many standard formularies. To get coverage in North Carolina: (1) Have your HAE specialist submit a prior authorization with confirmed HAE diagnosis and lab results,

How to Get Evrysdi (Risdiplam) Covered by Aetna in Ohio: Appeal Guide with Forms and Timelines

Answer Box: Getting Evrysdi Covered by Aetna in Ohio Fastest path to approval: Submit genetic testing documentation confirming biallelic SMN1 mutations, clinical SMA diagnosis, baseline motor assessments, and prior therapy history to Aetna's prior authorization process. If denied, file an internal appeal within 180 days, then request external

How to Get Mepsevii (Vestronidase Alfa-vjbk) Covered by UnitedHealthcare in California: Complete Prior Authorization Guide

Quick Answer: Getting Mepsevii Covered in California UnitedHealthcare requires prior authorization for Mepsevii (vestronidase alfa-vjbk) in California. To get approved: (1) Submit a PA request through the UnitedHealthcare provider portal with confirmed MPS VII diagnosis (enzyme/genetic testing), (2) Include specialist documentation and ICD-10 code E76.2, (3) If denied,

How to Get Ofev (nintedanib) Covered by Humana in Ohio: Forms, Appeals, and Contact Numbers

Answer Box: Getting Ofev (nintedanib) Covered by Humana in Ohio Ofev (nintedanib) requires prior authorization from Humana in Ohio. Your pulmonologist must submit clinical documentation through Humana's online portal or by fax to 877-486-2621. Required evidence includes HRCT confirming fibrosis, pulmonary function tests showing decline, and specialist attestation

The Complete Guide to Getting Rezlidhia (Olutasidenib) Covered by UnitedHealthcare in New Jersey: Requirements, Appeals, and Step Therapy

Answer Box: Getting Rezlidhia Covered in New Jersey UnitedHealthcare requires prior authorization for Rezlidhia (olutasidenib) in New Jersey, with specific requirements for documented IDH1 mutation and AML diagnosis. The fastest path: (1) Submit PA through the UnitedHealthcare Provider Portal with IDH1 mutation test results, (2) Include medical necessity letter addressing