Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1077 issues

How to Get Orkambi (lumacaftor/ivacaftor) Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Orkambi Covered in Washington UnitedHealthcare requires prior authorization for Orkambi (lumacaftor/ivacaftor) based on confirmed cystic fibrosis diagnosis, homozygous F508del CFTR mutation documentation, and prescription by a CF specialist. Submit through OptumRx with genetic lab results, ICD-10 E84.0-E84.9, and clinical notes. If denied, Washington residents

How to Get Crysvita (burosumab) Covered by UnitedHealthcare in Ohio: Complete Forms, Appeals, and Contact Guide

Answer Box: Getting Crysvita Covered in Ohio UnitedHealthcare requires prior authorization for Crysvita (burosumab) through OptumRx for X-linked hypophosphatemia (XLH) and tumor-induced osteomalacia. Submit via the UnitedHealthcare Provider Portal with genetic testing, low serum phosphorus labs, and specialist prescription. If denied, you have 180 days for internal appeals, then external

Coding That Helps Get Cystadane (Betaine Anhydrous) Approved by UnitedHealthcare in Georgia: ICD-10, Documentation, and PA Requirements

Answer Box: Getting Cystadane Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization (PA) for Cystadane (betaine anhydrous) via OptumRx with specific coding and documentation. Use ICD-10 code E72.11 (homocystinuria) or E72.12 (MTHFR deficiency) with genetic testing confirmation, elevated homocysteine labs, and documented vitamin B6/B12/folate failures.

UnitedHealthcare's Coverage Criteria for Acthar Gel in Florida: What Counts as "Medically Necessary"?

Answer Box: Getting Acthar Gel Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Acthar Gel with strict medical necessity criteria. Coverage is primarily limited to infantile spasms in children under 2 years old (4-week approval) and select conditions like opsoclonus-myoclonus syndrome. Most other uses require documented failure of

Getting Aldurazyme (Laronidase) Covered by UnitedHealthcare in Florida: Copay Assistance, Appeals, and Cost-Saving Strategies

Answer Box: Fast Track to Aldurazyme Coverage UnitedHealthcare requires prior authorization for Aldurazyme (laronidase) with genetic/enzymatic confirmation of MPS I and specialist oversight. Commercial members can use Sanofi's CareConnectPSS copay assistance (up to $15,000 annually), while Medicare/Medicaid members cannot. Florida's 2024 Patient Timely

How to Get Xywav Covered by UnitedHealthcare in North Carolina: PA Requirements, Appeals Process & State Protections

Answer Box: Getting Xywav Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Xywav with step therapy failures and REMS enrollment. In North Carolina, you have strong appeal rights including expedited external review through Smart NC. Start today: 1) Enroll in XYWAV/XYREM REMS program, 2) Gather sleep

How to Get Tegsedi (inotersen) Covered by UnitedHealthcare in Texas: Complete Prior Authorization Guide with Forms and Appeals

Answer Box: Getting Tegsedi (inotersen) Approved by UnitedHealthcare in Texas Quick Path to Coverage: UnitedHealthcare requires prior authorization for Tegsedi (inotersen) for hereditary transthyretin amyloidosis with polyneuropathy. You'll need: (1) confirmed hATTR diagnosis with TTR mutation, (2) REMS program enrollment for patient, prescriber, and pharmacy, and (3) baseline

How Long Does It Take to Get Thiola (Tiopronin) Approved by UnitedHealthcare in New Jersey? Timeline & Appeal Guide

Answer Box: Getting Thiola Approved by UnitedHealthcare in New Jersey Timeline: 1-5 business days for complete prior authorization submissions through OptumRx. UnitedHealthcare requires prior authorization for Thiola/Thiola EC (tiopronin) with step therapy documentation showing failure of conservative cystinuria management. Start here: Have your urologist/nephrologist gather 24-hour urine cystine

How to Get Humate-P Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Humate-P Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Humate-P (antihemophilic factor/vWF complex) in Pennsylvania, with step therapy requiring documentation of desmopressin (DDAVP) trial failure or contraindications. Submit PA via UHC Provider Portal with complete VWD subtype documentation, dosing calculations, and wastage justification. If

Get Photrexa Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Get Photrexa Covered by UnitedHealthcare in New York UnitedHealthcare covers FDA-approved Photrexa (riboflavin ophthalmic solution) for progressive keratoconus with prior authorization, but only for epithelium-off procedures using the iLink® system. In New York, if denied, you have strong appeal rights through the Department of Financial Services with expedited