Topic

Insurance Approval

A collection of 898 issues

Coding That Helps Get Idelvion (albutrepenonacog alfa) Approved by UnitedHealthcare in California: ICD-10, J-Code, and NDC Guide

Answer Box: Getting Idelvion Covered by UnitedHealthcare in California Idelvion (albutrepenonacog alfa) requires prior authorization from UnitedHealthcare with specific coding: Use ICD-10 code D67 (hereditary factor IX deficiency), HCPCS J7202 (1 IU per billing unit), and the correct NDC for your vial strength. Submit clinical documentation showing hemophilia B diagnosis,

When Fabrazyme Isn't Approved by UnitedHealthcare in Virginia: Formulary Alternatives & Exception Paths

Answer Box: Getting Fabrazyme Coverage Through UnitedHealthcare in Virginia If UnitedHealthcare denies Fabrazyme (agalsidase beta) for Fabry disease, you'll likely need to try their preferred alternative Elfabrio first due to step therapy requirements. Document any clinical reasons why Elfabrio isn't suitable, then request a formulary exception

Do You Qualify for Cystadane Coverage by Humana in Texas? Decision Tree & Next Steps

Answer Box: If you have confirmed homocystinuria with elevated homocysteine (>50 µmol/L) and documented CBS, MTHFR, or cobalamin deficiency, you likely qualify for Cystadane coverage through Humana in Texas. The fastest path: have your doctor submit prior authorization with genetic testing results, plasma homocysteine levels, and vitamin B6/

Get Mepsevii Covered by Humana in Pennsylvania: Prior Authorization Requirements and Appeal Process

Quick Answer: Humana requires prior authorization for Mepsevii (vestronidase alfa-vjbk) in Pennsylvania. Submit PA request with MPS VII diagnosis confirmation, weight-based dosing justification, and specialist documentation. If denied, file internal appeal within 60 days, then Pennsylvania external review within 4 months. Start by contacting your prescriber to initiate the PA

Work With Your Doctor to Get Ruconest Covered by Aetna CVS Health in Virginia: Provider Collaboration Guide

Quick Answer: Your Path to Ruconest Coverage Getting Ruconest (C1 esterase inhibitor [recombinant]) covered by Aetna CVS Health in Virginia requires prior authorization with specific lab documentation proving hereditary angioedema (HAE). Your fastest path: schedule an appointment with an HAE specialist (allergist/immunologist), gather your C1-INH and C4 lab results,

How to Get Galafold (migalastat) Covered by Cigna in Washington: Alternative Treatments and Appeal Options

Answer Box: Galafold (migalastat) Coverage by Cigna in Washington Getting Galafold covered by Cigna requires genetic confirmation of an amenable GLA variant plus prior authorization. If denied, you have strong appeal rights in Washington, including external review through an Independent Review Organization (IRO). Your 3-step path: 1. Confirm eligibility: Genetic

How to Get Tagrisso (osimertinib) Covered by UnitedHealthcare in California: Prior Authorization, Appeals & Cost Assistance

Answer Box: Getting Tagrisso Covered by UnitedHealthcare in California Quick answer: Tagrisso requires prior authorization from UnitedHealthcare but has $0 copay for covered patients. To get approved: (1) Submit PA with EGFR mutation test results through your doctor, (2) If denied, file internal appeal within 180 days, (3) Request California

Work With Your Doctor to Get Elelyso (taliglucerase alfa) Approved by Humana in Pennsylvania: Complete Provider Collaboration Guide

Answer Box: Get Elelyso (taliglucerase alfa) Covered by Humana in Pennsylvania Humana requires prior authorization for Elelyso (taliglucerase alfa) in Pennsylvania. Your physician must submit documentation proving confirmed Type 1 Gaucher disease diagnosis (enzyme testing + genetics), medical necessity, and consideration of formulary alternatives. If denied, you can appeal through Humana&

How to Get Kuvan (Sapropterin) Covered by Cigna in Washington: Appeals, Alternatives & Success Strategies

Answer Box: Getting Kuvan Covered by Cigna in Washington Cigna requires prior authorization for Kuvan (sapropterin dihydrochloride) for PKU treatment. Your fastest path to approval: (1) Have your metabolic specialist submit a PA request through Cigna's provider portal with documented PKU diagnosis, BH4 responsiveness testing showing ≥30% phenylalanine

How to Get Dupixent (dupilumab) Covered by Cigna in Michigan: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Started To get Dupixent (dupilumab) covered by Cigna in Michigan, you'll need prior authorization through their specialty pharmacy network. The fastest path: (1) Have your doctor submit a PA request via CoverMyMeds or the Cigna provider portal with complete clinical documentation, (2) Set up specialty