Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 127 issues

Denied for Adynovate by UnitedHealthcare in California? How to Appeal (Templates & Timelines)

Answer Box: Getting Adynovate Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Adynovate (bdanocog alfa pegol) with step therapy requirements. If denied, California residents can appeal through internal grievances, then request an Independent Medical Review (IMR) with high success rates for medically necessary treatments. First step today: Call
6 min read

Renewing Exondys 51 (Eteplirsen) Approval with UnitedHealthcare in North Carolina: 2025 Requirements & Timeline

Answer Box: Renewing Your Exondys 51 Coverage Quick Answer: UnitedHealthcare requires annual renewal of Exondys 51 (eteplirsen) prior authorization with updated clinical documentation. Start the renewal process 60-90 days before your current authorization expires. You'll need: neurologist evaluation showing continued benefit, updated cardiac/renal function tests, and proof
6 min read

Coding That Helps Get Oxervate (cenegermin) Approved by UnitedHealthcare in California: ICD-10, HCPCS, and NDC Guide

Answer Box: Getting Oxervate Covered by UnitedHealthcare in California Oxervate (cenegermin) requires prior authorization from UnitedHealthcare with specific coding requirements. Use ICD-10 codes H16.231-H16.233 for stage 2/3 neurotrophic keratitis, HCPCS code J3590, and NDC 71923-019-01. Submit through OptumRx with documented artificial tear failure and ophthalmologist prescription. If
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How to Get Vitrakvi (Larotrectinib) Covered by UnitedHealthcare in Florida: 2025 PA Requirements and Appeal Guide

Quick Answer: Getting Vitrakvi Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Vitrakvi (larotrectinib) in Florida. To get approved: (1) Submit a PA request through OptumRx with confirmed NTRK gene fusion testing results, (2) document that your solid tumor is metastatic/unresectable with no satisfactory alternatives, and (3)
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Lowering Out-of-Pocket for Pemazyre (Pemigatinib) with UnitedHealthcare in New Jersey: Copay, Tiering & Assistance

Answer Box: Getting Pemazyre (Pemigatinib) Covered by UnitedHealthcare in New Jersey Pemazyre (pemigatinib) requires prior authorization from UnitedHealthcare and is placed on the specialty tier through OptumRx. Your first step is ensuring your oncologist has documented FGFR2 fusion/rearrangement (for cholangiocarcinoma) or FGFR1 rearrangement (for myeloid/lymphoid neoplasms) via molecular
5 min read

How to Get Vitrakvi (Larotrectinib) Covered by UnitedHealthcare in Texas: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Vitrakvi Covered in Texas UnitedHealthcare requires prior authorization for Vitrakvi (larotrectinib) in Texas. For patients under 19, approval requires only age verification. Adults need documented NTRK gene fusion, metastatic/unresectable tumor, and no satisfactory alternatives. Submit the UnitedHealthcare PA form with molecular testing results through the provider
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Work With Your Doctor to Get Orladeyo (Berotralstat) Approved by UnitedHealthcare in Georgia: Forms, Appeal Scripts, and Clinical Documentation Guide

Answer Box: Getting Orladeyo Covered by UnitedHealthcare in Georgia Orladeyo (berotralstat) requires prior authorization from UnitedHealthcare with step therapy documentation showing failure or contraindication to first-line HAE prophylaxis treatments. Your allergist/immunologist must submit a medical necessity letter proving ≥1 moderate-to-severe HAE attack monthly and that alternatives like Cinryze or
6 min read

UnitedHealthcare's Coverage Criteria for Evkeeza in Texas: What Counts as "Medically Necessary"?

Answer Box: Getting Evkeeza Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Evkeeza (evinacumab-dgnb) with strict medical necessity criteria. You'll need documented homozygous familial hypercholesterolemia (HoFH), genetic testing or LDL-C ≥300 mg/dL on maximally tolerated therapy, and evidence of failed standard treatments. First step: Have
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Coding That Helps Get Elaprase (Idursulfase) Approved in Virginia with UnitedHealthcare: ICD-10, HCPCS/J-Code, and NDC Guide

Answer Box: Getting Elaprase Covered by UnitedHealthcare in Virginia Fast track to approval: Use ICD-10 code E76.1 (Hunter syndrome), HCPCS J1743 for billing, and NDC 54092-0700-01. Submit prior authorization through UnitedHealthcare Provider Portal with enzymatic/genetic test results confirming Hunter syndrome diagnosis. If denied, file Virginia external review using
6 min read