Topic

Insurance Approval

A collection of 6349 issues

How to Get Luxturna (voretigene neparvovec-rzyl) Covered by Blue Cross Blue Shield California: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Luxturna Covered in California Blue Shield of California requires prior authorization for Luxturna (voretigene neparvovec-rzyl) with specific criteria: confirmed biallelic RPE65 mutation via genetic testing, documented viable retinal cells, and no prior gene therapy. Submit clinical documentation via fax for review. If denied, file an internal appeal
5 min read

How to Get Spinraza (Nusinersen) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Timeline and Appeals Guide

Answer Box: Getting Spinraza Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield plans in Pennsylvania require prior authorization for Spinraza (nusinersen) with genetic confirmation of 5q SMA and specialist prescriber documentation. Standard approval takes 5-14 days; expedited decisions within 72 hours for urgent cases. Pennsylvania'
7 min read

How to Get Ofev (nintedanib) Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Ofev Approved by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Ofev (nintedanib) with specific criteria: pulmonologist prescription, confirmed IPF/SSc-ILD/progressive fibrosing ILD diagnosis, HRCT evidence of fibrosis, and PFT decline documentation. Submit via the UnitedHealthcare provider portal with complete clinical records. If denied, Pennsylvania'
6 min read

How to Get Voydeya (danicopan) Covered by UnitedHealthcare in New Jersey: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Voydeya Covered by UnitedHealthcare in New Jersey Voydeya (danicopan) requires prior authorization from UnitedHealthcare for paroxysmal nocturnal hemoglobinuria (PNH). Key requirements: ICD-10 code D59.5, proof of extravascular hemolysis despite C5 inhibitor therapy, completed vaccinations (meningococcal, pneumococcal, Hib), and REMS enrollment. Submit via UnitedHealthcare Provider Portal with
5 min read

How to Get Elfabrio (Pegunigalsidase Alfa) Covered by Cigna in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Elfabrio Covered by Cigna in Pennsylvania Cigna requires prior authorization for Elfabrio (pegunigalsidase alfa-iwxj) in Pennsylvania through Express Scripts/Accredo specialty pharmacy. Submit the Elfabrio CCRD PA form with confirmed Fabry disease diagnosis (deficient α-galactosidase A enzyme <4% normal OR pathogenic GLA gene variant), age 18+
6 min read

How to Get Xembify (Immune Globulin, SC) Covered by Humana in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Xembify Covered by Humana in Texas Xembify (immune globulin, SC) requires prior authorization from Humana with documentation of primary immunodeficiency diagnosis, IgG levels <2 standard deviations below normal, and ≥2 serious infections annually. Submit through Humana's provider portal with complete clinical records. Standard decisions
6 min read