Topic

Insurance Approval

A collection of 1091 issues

Get Haegarda Covered by Humana in Illinois: Prior Authorization Guide & Appeal Process

Answer Box: Getting Haegarda Covered by Humana in Illinois Humana requires prior authorization for Haegarda (C1-esterase inhibitor, SC) with step therapy documentation showing trial of preferred HAE alternatives first. In Illinois, you have 65 days to appeal denials and 30 days for external review if internal appeals fail. Start today:

How to Get Enbrel (Etanercept) Covered by Humana in Georgia: Prior Authorization, Appeals, and Medical Necessity Requirements

Answer Box: Getting Enbrel Covered by Humana in Georgia Humana requires prior authorization and step therapy for Enbrel (etanercept) in Georgia. You must try preferred alternatives first, provide TB screening within 12 months, and document medical necessity through a specialist. If denied, you have 65 days to appeal internally, then

How to Get Increlex (Mecasermin) Covered by UnitedHealthcare in Texas: Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Increlex Covered by UnitedHealthcare in Texas Increlex (mecasermin) requires prior authorization from UnitedHealthcare and must be dispensed through specific specialty pharmacies (Accredo, BriovaRx, CVS Specialty, or Walgreens Specialty). To get approved: 1. Submit prior authorization with documented severe primary IGF-1 deficiency diagnosis, growth charts, and lab results

How to Get Qalsody (Tofersen) Covered by Aetna CVS Health in Texas: Prior Authorization, Appeals & Success Strategies

Answer Box: Getting Qalsody Covered by Aetna CVS Health in Texas Aetna CVS Health requires prior authorization for Qalsody (tofersen) and covers it only for adults with confirmed SOD1-mutation ALS. Your fastest path to approval: (1) Confirm SOD1 genetic testing results, (2) Have a neurologist submit the prior authorization with

How to Get Thiola / Thiola EC (Tiopronin) Covered by UnitedHealthcare in Florida: Complete Coding, Appeals & Approval Guide

Answer Box: Getting Thiola/Thiola EC Covered by UnitedHealthcare in Florida Thiola (tiopronin) requires prior authorization from UnitedHealthcare OptumRx for cystinuria treatment. The fastest path to approval: 1) Ensure your provider documents cystinuria diagnosis (ICD-10: E72.01) with 24-hour urine cystine levels and stone history, 2) Submit prior authorization through

Getting Zolgensma Covered by Cigna in Washington: Complete Guide to Prior Authorization, Appeals, and IRO Process

Answer Box: Your Fastest Path to Approval To get Zolgensma (onasemnogene abeparvovec-xioi) covered by Cigna in Washington, you need: (1) genetic confirmation of bi-allelic SMN1 mutation, (2) anti-AAV9 antibody titer ≤ 1:50, and (3) steroid protocol documentation. Submit Cigna's prior authorization form with all clinical records to their

Myths vs. Facts: Getting Turalio (pexidartinib) Covered by Blue Cross Blue Shield in Georgia

Answer Box: Getting Turalio Covered by Blue Cross Blue Shield in Georgia Blue Cross Blue Shield (BCBS) of Georgia requires prior authorization for Turalio (pexidartinib) to treat symptomatic TGCT not amenable to surgery. Key requirements: confirmed TGCT diagnosis, documented surgical inoperability, severe morbidity/functional limitations, and completed REMS enrollment with

How to Get Tepezza (Teprotumumab) Covered by Humana in Washington: Forms, Appeals, and Approval Strategies

Answer Box: Your Fastest Path to Tepezza Coverage Tepezza (teprotumumab) requires prior authorization from Humana Medicare Advantage plans in Washington. Your ophthalmologist must document moderate-to-severe active thyroid eye disease (CAS ≥3) and submit clinical evidence through Humana's medical benefit system using J3241 billing code. Three steps to start

How to Get Vimizim (Elosulfase Alfa) Covered by UnitedHealthcare in Georgia: Appeals, Forms, and State Protections

Answer Box: Getting Vimizim Covered in Georgia Vimizim (elosulfase alfa) requires prior authorization from UnitedHealthcare in Georgia. Your fastest path to approval: (1) Ensure your prescriber is a metabolic specialist or geneticist, (2) Submit GALNS enzyme testing results or genetic confirmation of MPS IVA, and (3) Include baseline functional assessments

How to Get Palynziq (pegvaliase) Covered by Cigna in New Jersey: Prior Authorization Forms, Appeal Process, and REMS Requirements

Quick Answer: Getting Palynziq Covered by Cigna in New Jersey Palynziq (pegvaliase) requires prior authorization from Cigna and strict compliance with FDA REMS requirements. Your fastest path to approval: (1) Ensure your prescriber is REMS-certified and you're enrolled in the program, (2) Submit prior authorization through the Cigna