Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1143 issues

Do You Qualify for Stelara (Ustekinumab) Coverage by UnitedHealthcare in Virginia? Decision Tree & Next Steps

Answer Box: Getting Stelara Covered by UnitedHealthcare in Virginia Quick Answer: UnitedHealthcare now prefers biosimilars (Steqeyma, Yesintek) over brand Stelara as of September 2024. To qualify for Stelara coverage, you'll need prior authorization showing medical necessity and documented failure/intolerance to preferred alternatives. First step: Have your doctor

How to Get Thiola / Thiola EC (tiopronin) Covered by UnitedHealthcare in Texas: Prior Authorization, Appeals, and Billing Guide

Quick Answer: UnitedHealthcare requires prior authorization for Thiola/Thiola EC (tiopronin) with step therapy requirements in Texas. Success requires documenting cystinuria diagnosis (ICD-10: E72.01), failed conservative therapy, and specialist evaluation. If denied, Texas law provides internal appeals (180 days) and binding external review through Independent Review Organizations (IROs). Start

How to Get Cometriq (Cabozantinib) Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Cometriq Covered by UnitedHealthcare in Washington Fastest path to approval: Submit prior authorization through UnitedHealthcare's provider portal with complete medical records documenting medullary thyroid carcinoma diagnosis, progression status, and treatment history. If denied, pursue internal appeals (180 days) followed by Washington's Independent Review

How to Get Ilaris (Canakinumab) Covered by UnitedHealthcare in Texas: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Getting Ilaris Covered by UnitedHealthcare in Texas Fastest path to approval: Submit prior authorization through a rheumatologist or immunologist with complete diagnosis documentation, lab values, and prior treatment failures. Ilaris is Tier 2 on OptumRx formularies, requires specialty pharmacy dispensing, and has quantity limits (0.08 mL/day)

Resources to Get Rylaze Covered by UnitedHealthcare in Texas: Complete Forms, Portals & Contact Guide

Answer Box: Getting Rylaze Covered by UnitedHealthcare in Texas Rylaze requires prior authorization from UnitedHealthcare in Texas. Submit requests through the UnitedHealthcare Provider Portal using drug code J9358, with documented hypersensitivity to E. coli asparaginase. First step today: Verify your specific plan's formulary status and gather hypersensitivity documentation.

How to Get Voxzogo (Vosoritide) Covered by UnitedHealthcare in Ohio: Complete PA Guide with Forms and Appeal Process

Answer Box: Getting Voxzogo Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Voxzogo (vosoritide) in Ohio. To get approved: (1) Gather genetic testing confirming FGFR3 mutation, bone age X-ray showing open growth plates, and 12+ months of growth data, (2) Have a pediatric endocrinologist or geneticist submit the

How to Get Dupixent Covered by UnitedHealthcare in Florida: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Dupixent Covered by UnitedHealthcare in Florida Fastest path to approval: UnitedHealthcare requires prior authorization for Dupixent through OptumRx, with specific step therapy requirements varying by indication. For atopic dermatitis, avoid concurrent biologics/JAK inhibitors. For asthma, document eosinophilic phenotype (≥150 cells/μL) or oral steroid dependence plus

Renewing iLink® Corneal Cross-Linking Approval with UnitedHealthcare in Florida: Complete Timeline & Documentation Guide

Answer Box: Renewing iLink® Coverage with UnitedHealthcare in Florida UnitedHealthcare requires prior authorization renewal for iLink® corneal cross-linking treatments in Florida, typically needed every 6-12 months or after completing initial treatment phases. Submit renewal requests at least 10 business days before your next scheduled procedure through the UHC Provider Portal.

How to Get Filsuvez Covered by UnitedHealthcare in Texas: Complete Prior Authorization Guide with Forms and Appeal Scripts

Answer Box: Getting Filsuvez Covered by UnitedHealthcare in Texas Filsuvez requires prior authorization from UnitedHealthcare for epidermolysis bullosa treatment in Texas. Your fastest path to approval: (1) Confirm your diagnosis is dystrophic or junctional EB with genetic testing, (2) Document wound size (10-50 cm²) and duration (3+ weeks), and (3)

Myths vs. Facts: Getting Gilenya (fingolimod) Covered by UnitedHealthcare in New York

Answer Box: Getting Gilenya Covered by UnitedHealthcare in New York Bottom line: UnitedHealthcare requires prior authorization and step therapy for Gilenya (fingolimod), but coverage is achievable with proper documentation. Most denials stem from missing baseline tests (EKG, eye exam), incomplete step therapy records, or inadequate medical necessity documentation. Fastest path: