Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 116 issues

Getting Entresto (Sacubitril/Valsartan) Covered by UnitedHealthcare in New Jersey: Complete Guide to Prior Authorization and Appeals

Quick Answer: UnitedHealthcare requires prior authorization for Entresto in New Jersey with specific criteria: heart failure diagnosis, LVEF ≤40% or structural heart disease, NYHA Class II-IV, cardiologist prescription, and discontinuation of ACE inhibitors/ARBs. Submit through the UnitedHealthcare provider portal or fax to 1-866-434-5523. If denied, you have 180 days

Getting Mepsevii (Vestronidase Alfa) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval To get Mepsevii (vestronidase alfa-vjbk) covered by UnitedHealthcare in New Jersey: Submit prior authorization through OptumRx with complete MPS VII diagnostic proof (enzyme assay, genetic testing, elevated uGAGs) from a metabolic specialist. If denied, file internal appeal within 180 days, then external review through

How to Get Signifor/Signifor LAR Covered by UnitedHealthcare in Illinois: Complete Guide to Prior Authorization, Appeals & Forms

Quick Answer: Getting Signifor/Signifor LAR Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Signifor (pasireotide) in Illinois. For Cushing's disease: coverage is approved when pituitary surgery isn't an option or hasn't been curative—no step therapy required. For acromegaly: you must

How to Get Isturisa (Osilodrostat) Covered by UnitedHealthcare in Washington: Requirements Checklist and Appeals Guide

Answer Box: Getting Isturisa Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Isturisa (osilodrostat) for adult Cushing's disease patients who aren't surgical candidates or had unsuccessful surgery. The fastest path to approval: 1) Confirm your diagnosis with elevated urinary free cortisol and endocrinologist consultation,

How to Get Chenodal (chenodiol) Covered by UnitedHealthcare in Florida: Prior Authorization Forms, Appeals, and Step-by-Step Guide

Answer Box: Getting Chenodal Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Chenodial (chenodiol) and places it on a non-preferred specialty tier. Coverage is limited to cerebrotendinous xanthomatosis (CTX) with genetic confirmation—not gallstone dissolution. First step: Have your specialist submit a PA request through the UnitedHealthcare Provider

Getting Cystadane (Betaine Anhydrous) Covered by UnitedHealthcare in Texas: Prior Authorization, Appeals & Cost Assistance

Answer Box: Getting Cystadane Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Cystadane (betaine anhydrous) and typically places it on Tier 3/4 specialty tiers. In Texas, you have 60 days to appeal denials internally, followed by external review through an Independent Review Organization (IRO) if needed. Start

How to Get Ofev (nintedanib) Covered by UnitedHealthcare in Michigan: Prior Authorization, Appeals, and State Protections

Answer Box: Quick Path to Ofev Coverage UnitedHealthcare requires prior authorization for Ofev (nintedanib) in Michigan with specific documentation: pulmonologist evaluation, confirmed IPF/ILD diagnosis, HRCT showing fibrosis, and PFT decline evidence. If denied, you have strong appeal rights through Michigan's 127-day external review process via DIFS. Your

How to Get Tavneos (Avacopan) Covered by UnitedHealthcare in California: Complete Appeals Guide with Templates

Answer Box: Getting Tavneos Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Tavneos (avacopan) with strict criteria: severe active ANCA-associated vasculitis (GPA/MPA), use alongside standard therapy (rituximab or cyclophosphamide plus steroids), and specialist prescriber. If denied, California residents can appeal through UnitedHealthcare's internal process, then

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 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