Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1054 issues

How to Get Photrexa (Riboflavin Ophthalmic Solution) Covered by UnitedHealthcare in Michigan: Prior Authorization Timeline & Appeals Guide

Answer Box: Getting Photrexa Covered in Michigan Photrexa (riboflavin ophthalmic solution) requires prior authorization from UnitedHealthcare for corneal cross-linking in progressive keratoconus. The fastest path to approval: (1) Submit PA through the UHC Provider Portal with serial topography showing ≥1 diopter Kmax progression over 12 months, (2) Include pachymetry confirming
5 min read

Work With Your Doctor to Get Onivyde (Irinotecan Liposome) Approved by UnitedHealthcare in Texas: PA Requirements and Appeal Scripts

Quick Answer: Getting Onivyde Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization through OptumRx for Onivyde (irinotecan liposome) in metastatic pancreatic cancer, with ECOG 0-1 status and adequate organ function documented. Your oncologist must submit clinical notes showing either first-line NALIRIFOX eligibility or gemcitabine failure, with decisions typically within
6 min read

How to Get Arcalyst (Rilonacept) Covered by UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Arcalyst Approved by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Arcalyst (rilonacept) with 12-month approvals based on FDA indications: CAPS, DIRA, or recurrent pericarditis. Submit PA forms via the provider portal with specialist notes, diagnosis confirmation (ICD-10 codes), and clinical documentation. If denied, you have 180
5 min read

Getting Somatuline Depot (Lanreotide) Covered by UnitedHealthcare in California: Complete Prior Authorization and Billing Guide

Answer Box: Your Path to Coverage Getting Somatuline Depot (lanreotide) covered by UnitedHealthcare in California requires prior authorization through OptumRx. Start with proper medical coding: ICD-10 E22.0 for acromegaly or appropriate NET codes, HCPCS J1930 (1 mg per unit), and correct NDCs. UnitedHealthcare often requires step therapy with octreotide
5 min read

How to Get Vitrakvi (Larotrectinib) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Vitrakvi Coverage To get Vitrakvi (larotrectinib) covered by UnitedHealthcare in North Carolina: Submit prior authorization via OptumRx with validated NTRK gene fusion test results, oncologist medical necessity letter documenting metastatic/unresectable disease, and prior therapy history. If denied, file internal appeal within 180 days, then
4 min read

The Requirements Checklist to Get Advate (octocog alfa) Covered by UnitedHealthcare in Illinois: Complete PA and Appeal Guide

Answer Box: Getting Advate Covered by UnitedHealthcare in Illinois Advate (octocog alfa) requires prior authorization through UnitedHealthcare's OptumRx with step therapy requirements favoring preferred Factor VIII products. The fastest path to approval: 1) Submit complete PA with hemophilia A diagnosis (ICD-10: D66), inhibitor-negative status, and bleeding history via
5 min read

How to Get Ocrevus (Ocrelizumab) Covered by UnitedHealthcare in Florida: Complete Guide with Forms, Appeals, and Timelines

Answer Box: Getting Ocrevus Covered by UnitedHealthcare in Florida Yes, UnitedHealthcare covers Ocrevus (ocrelizumab) for multiple sclerosis, but requires prior authorization with specific documentation. Your neurologist submits the PA request through the UHC Provider Portal or by fax to 866-940-7328, including MS diagnosis confirmation, hepatitis B screening results, and evidence
6 min read

How to Get Cabometyx (Cabozantinib) Covered by UnitedHealthcare in Washington: Complete PA Guide with ICD-10 Codes and Appeals

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization (PA) for Cabometyx (cabozantinib tablets) through OptumRx for all FDA-approved cancer indications in Washington. Submit PA with confirmed diagnosis (ICD-10: C64 for RCC, C22.0 for HCC), prior therapy documentation, and RECIST imaging showing progression. If denied,
6 min read