Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1065 issues

Resources to Get Krystexxa (Pegloticase) Approved with UnitedHealthcare in Washington: Complete Forms, Portals & Contact Directory

Answer Box: Getting Krystexxa Covered by UnitedHealthcare in Washington Krystexxa (pegloticase) requires prior authorization through OptumRx for UnitedHealthcare plans in Washington. Submit via the UnitedHealthcare Provider Portal with documented failure of xanthine oxidase inhibitors (allopurinol ≥300mg daily, febuxostat), persistent serum uric acid >6 mg/dL, G6PD testing, and rheumatologist
6 min read

Lowering Out-of-Pocket Costs for Procysbi with UnitedHealthcare in Michigan: Copay Cards, Tier Exceptions & Appeals

Answer Box: Getting Procysbi Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Procysbi (cysteamine bitartrate DR) and typically mandates step therapy with immediate-release cysteamine first. Michigan residents have 180 days to appeal denials internally, then 127 days for external review through Michigan DIFS. First step: Have your doctor
6 min read

How to Get Firdapse (Amifampridine) Covered by UnitedHealthcare in Texas: Appeals Process, Forms, and Approval Scripts

Answer Box: Getting Firdapse Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Firdapse (amifampridine) in Texas with no step therapy requirement. Submit via the UHC Provider Portal with confirmed LEMS diagnosis (P/Q-type VGCC antibodies + EMG showing ≥60% CMAP increment), neurologist prescription, and no seizure history. Standard approval
5 min read

The Requirements Checklist to Get Revlimid (lenalidomide) Covered by UnitedHealthcare in North Carolina

Answer Box: Getting Revlimid Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Revlimid (lenalidomide) in North Carolina, with specific criteria for multiple myeloma, MDS, and mantle cell lymphoma. The fastest path: verify REMS enrollment, submit PA via UHC provider portal with diagnosis-specific documentation, and use North Carolina&
5 min read

How to Get Ocrevus (Ocrelizumab) Covered by UnitedHealthcare in California: Renewal Guide, Appeal Scripts, and Timeline

Answer Box: Getting Ocrevus Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Ocrevus (ocrelizumab) with annual renewal documentation showing clinical response. Submit via the UHC Provider Portal with MS diagnosis confirmation, prior DMT trials, and evidence of treatment benefit (stable/improved disability scores, reduced relapses, or MRI stability)
6 min read

How to Get Pombiliti (cipaglucosidase alfa-atga) Covered by UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: To get Pombiliti (cipaglucosidase alfa-atga) covered by UnitedHealthcare in Florida, you'll need prior authorization with documented failure on current ERT (step therapy). Submit via UHCprovider.com or OptumRx forms (fax 844-403-1027). Include late-onset Pompe diagnosis, enzyme/genetic testing, and prior therapy outcomes. If denied, appeal within
5 min read

How to Get Zolgensma (onasemnogene abeparvovec) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in Michigan Fastest Path to Approval: UnitedHealthcare requires prior authorization for Zolgensma through their medical benefit policy. You need genetic testing confirming bi-allelic SMN1 mutations, age under 24 months at infusion, anti-AAV9 antibody titer ≤1:50, and treatment at a certified center. If
6 min read

How Long Does It Take to Get Duopa (Carbidopa/Levodopa Enteral) Approved by UnitedHealthcare in Virginia? Complete Timeline & Appeals Guide

Answer Box: Getting Duopa Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization (PA) for Duopa (carbidopa/levodopa enteral) with 15-day standard review or 72-hour expedited review for urgent cases. Success requires documenting advanced Parkinson's disease, failed oral therapy, and planned PEG-J tube placement. First step: Have your
6 min read

Lowering Out-of-Pocket Costs for Ruconest with UnitedHealthcare in North Carolina: Copay Cards, Appeals & Financial Assistance

Answer Box: Getting Ruconest Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Ruconest (C1 esterase inhibitor [recombinant]) in North Carolina, with 12-month approvals for confirmed hereditary angioedema (HAE) patients prescribed by allergists/immunologists. The fastest path: 1) Have your HAE specialist submit PA via UHC Provider Portal
6 min read