Topic

Insurance Approval

A collection of 626 issues

How to Get Turalio (Pexidartinib) Covered by Humana in New York: Coding, Prior Authorization, and Appeals Guide

Answer Box: Getting Turalio Covered by Humana in New York Turalio (pexidartinib) requires prior authorization from Humana for tenosynovial giant cell tumor (TGCT) when surgery isn't an option. First step today: Ensure your prescriber is REMS-certified and gather baseline liver function tests. Submit PA via Humana's

How to Get Turalio (Pexidartinib) Covered by Blue Cross Blue Shield in Florida: Complete Appeals Guide with Templates

Answer Box: Quick Path to Turalio Coverage To get Turalio (pexidartinib) covered by Blue Cross Blue Shield in Florida: 1) Ensure complete REMS enrollment (prescriber, patient, pharmacy), 2) Submit prior authorization with TGCT diagnosis documentation and surgical contraindications, 3) If denied, file internal appeal within 180 days with medical necessity

Get Raxone (Idebenone) Covered by Blue Cross Blue Shield in Georgia: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Raxone (Idebenone) Covered in Georgia Raxone (idebenone) is not FDA-approved in the US, making coverage challenging through Blue Cross Blue Shield in Georgia. However, you have options: (1) Request a formulary exception with comprehensive LHON documentation, (2) explore compassionate use programs while FDA review is pending (target

How to Get Photrexa (Riboflavin) Covered by Humana in Illinois: Coding, Appeals & Prior Authorization Guide

Answer Box: Getting Photrexa Covered by Humana in Illinois Photrexa (riboflavin ophthalmic solution) requires prior authorization from Humana for corneal collagen cross-linking in progressive keratoconus or corneal ectasia. The fastest path to approval: 1) Use correct codes (ICD-10 H18.62x for unstable keratoconus, HCPCS J2787 x2 units, CPT 0402T), 2)

Myths vs. Facts: Getting Rystiggo (Rozanolixizumab-Noli) Covered by Humana in Florida

Answer Box: Rystiggo Coverage by Humana in Florida Getting Rystiggo (rozanolixizumab-noli) covered by Humana in Florida requires prior authorization with documented AChR or MuSK antibody-positive generalized myasthenia gravis and failure of standard therapies. The fastest path: ensure your neurologist submits complete PA documentation showing inadequate response to acetylcholinesterase inhibitors, steroids,

How to Get Cresemba (Isavuconazole) Covered by UnitedHealthcare in Washington: Prior Authorization Guide

Answer Box: Quick Path to Cresemba Coverage UnitedHealthcare requires prior authorization for Cresemba (isavuconazole) in Washington. Your fastest path: (1) Confirm diagnosis codes B44.0 (invasive aspergillosis) or B46.x (mucormycosis), (2) Document any voriconazole contraindications or failures, and (3) Submit PA request via UnitedHealthcare Provider Portal within 180 days.

How to Get Gattex (teduglutide) Covered by Blue Cross Blue Shield of Illinois: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Gattex Approved in Illinois To get Gattex (teduglutide) covered by Blue Cross Blue Shield of Illinois, you need prior authorization showing short bowel syndrome with parenteral nutrition dependence. Submit clinical documentation including PN logs, specialist attestation, and failed alternative therapies. If denied, you have 60 days to

How to Get Dojolvi (Triheptanoin) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide & Appeal Scripts

Answer Box: Getting Dojolvi Covered by UnitedHealthcare in Pennsylvania Quick Path to Approval: UnitedHealthcare requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of long-chain fatty acid oxidation disorder (LCFAOD), prescription by a board-certified medical geneticist, and no concurrent MCT oil use. If denied, Pennsylvania's new external review

How to Get Daybue (Trofinetide) Covered by Cigna in New Jersey: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Daybue Covered by Cigna in New Jersey Daybue (trofinetide) requires prior authorization from Cigna with specific documentation for Rett syndrome patients ≥2 years old. Your fastest path to approval: (1) Have your neurologist submit PA with confirmed MECP2 genetic testing and Clinical Severity Scale scores, (2) coordinate

Getting Emgality (galcanezumab-gnlm) Covered by Humana in California: Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Emgality Covered by Humana in California Emgality (galcanezumab-gnlm) requires prior authorization from Humana and is typically placed on a high-tier formulary. Your fastest path to approval: have your doctor submit a PA request documenting your migraine diagnosis, failure of 2+ preventive medications, and medical necessity. If denied,