Topic

New York

A collection of 424 issues

Renewing StrataGraft Coverage with Blue Cross Blue Shield in New York: Complete Guide to Documentation, Timelines, and Appeals

Answer Box: Getting StrataGraft Renewal Approved by Blue Cross Blue Shield in New York StrataGraft renewals require prior authorization as a facility-billed medical service through Blue Cross Blue Shield plans in New York (Anthem, Empire, Excellus, BCBS of WNY). Start renewal requests 2-3 weeks before your next treatment date. Submit

How to Get Chenodal (Chenodiol) Covered by UnitedHealthcare in New York: Complete Guide with Forms, Appeals, and Step-by-Step Process

Answer Box: Getting Chenodal (Chenodiol) Covered by UnitedHealthcare in New York Current Coverage Status: UnitedHealthcare requires prior authorization for Chenodal (chenodiol) but coverage is now restricted to cerebrotendinous xanthomatosis (CTX) only. Gallstone dissolution is no longer a covered indication. Fastest Path to Approval: 1. Confirm CTX diagnosis with genetic testing

Getting Kymriah (Tisagenlecleucel) Covered by Humana in New York: Complete Appeal Guide with Forms and Deadlines

Quick Answer: How to Get Kymriah Approved by Humana in New York If Humana denies Kymriah (tisagenlecleucel), you have strong appeal rights in New York. First step: Request your oncologist submit a medical necessity letter addressing Humana's CAR-T policy criteria within 60 days. If denied again: File a

How to Get Prolastin-C Covered by Aetna in New York: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Prolastin-C Covered by Aetna in New York Prolastin-C requires prior authorization from Aetna in New York. To get approved: (1) Have your pulmonologist complete Aetna's Alpha-1 Proteinase Inhibitors PA form with severe genotype (Pi*ZZ), FEV1 30-65% predicted, and non-smoking status, (2) Submit via phone

The Complete Requirements Checklist to Get Jaypirca (Pirtobrutinib) Covered by Humana in New York

Answer Box: Your Fastest Path to Approval Eligibility: Adults with relapsed/refractory mantle cell lymphoma or CLL/SLL after prior BTK inhibitor therapy covered by Humana Medicare Advantage or commercial plans in New York. Fastest approval path: 1) Verify prior authorization requirement using Humana's PA search tool, 2)

How to Get Berinert (C1-esterase inhibitor, IV) Covered by Humana in New York: Complete Guide to Prior Authorization, Appeals, and Coding

Answer Box: Getting Berinert Covered by Humana in New York Berinert (C1-esterase inhibitor, IV) requires prior authorization from Humana for hereditary angioedema (HAE) treatment. Fastest path: Have your doctor submit a PA request with HAE diagnosis (ICD-10: D84.1), lab results showing low C4 and C1-INH levels, and documentation of

How to Get Ferriprox (deferiprone) Covered by Humana in New York: Prior Authorization Guide and Appeal Process

Answer Box: Getting Ferriprox (deferiprone) Covered by Humana in New York Ferriprox requires prior authorization from Humana Medicare plans. Start by having your hematologist submit the Humana Medicare Part D coverage determination form with documentation of transfusional iron overload, prior chelator trials, and ANC monitoring plan. If denied, you have

How to Get Fabrazyme (agalsidase beta) Covered by Cigna in New York: Prior Authorization, Appeals, and State Review Options

Answer Box: Getting Fabrazyme Covered by Cigna in New York Cigna typically covers Fabrazyme (agalsidase beta) for confirmed Fabry disease as a specialty medication requiring prior authorization. Fastest path to approval: Have your specialist (geneticist, metabolic endocrinologist, or nephrologist) submit a complete PA request through Cigna's provider portal

How to Get Therakos CELLEX Photopheresis Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Your Fast Track to Coverage Therakos CELLEX photopheresis is covered by Blue Cross Blue Shield plans in New York for CTCL and steroid-refractory GVHD when medical necessity criteria are met. The fastest path: have your hematologist/oncologist or dermatologist submit prior authorization with complete staging documentation, steroid-refractory evidence

How to Get Krystexxa (Pegloticase) Covered by Cigna in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Krystexxa Covered by Cigna in New York Fastest path to approval: Document failed trials of allopurinol AND febuxostat (3+ months each at max doses), get G6PD testing, and have your rheumatologist submit Cigna's Krystexxa PA form with detailed medical necessity letter. If denied, file internal