Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1117 issues

Myths vs. Facts: Getting Naglazyme (galsulfase) Covered by UnitedHealthcare in Virginia

Quick Answer: What Actually Gets Naglazyme Covered by UnitedHealthcare in Virginia Reality check: A prescription alone isn't enough. UnitedHealthcare requires prior authorization with confirmed MPS VI diagnosis (enzyme assay + genetic testing), baseline functional tests (12-minute walk, stair climbing), and specialist documentation. If denied, Virginia gives you 180 days

Renewing Chenodal (Chenodiol) Approval with UnitedHealthcare in Washington: 2025 Requirements & Timeline

Answer Box: Chenodal (Chenodiol) Renewal with UnitedHealthcare in Washington UnitedHealthcare typically requires annual prior authorization renewal for Chenodal (chenodiol) with documentation of clinical response and safety monitoring. Start your renewal 60 days before expiration. Submit through the UnitedHealthcare Provider Portal with updated imaging, liver function tests, and a progress note.

UnitedHealthcare's Coverage Criteria for Rylaze in Georgia: What Counts as "Medically Necessary"?

Answer Box: Getting Rylaze Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Rylaze with documented hypersensitivity to E. coli asparaginase (pegaspargase). Key requirements: confirmed ALL/LBL diagnosis, age ≥1 month, detailed reaction records, and oncologist prescription. First step today: Have your oncology team submit a PA through the

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tepezza Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Tepezza (teprotumumab, HCPCS J3241) under the medical benefit. To get approval: 1) Submit PA via UHC Provider Portal with thyroid eye disease diagnosis, Clinical Activity Score ≥3, recent thyroid labs, and documented steroid trial/contraindication. 2)

How to Get Entresto (sacubitril/valsartan) Covered by UnitedHealthcare in California: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Entresto Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Entresto (sacubitril/valsartan) in California, with approval typically taking 72 hours when proper documentation is submitted. Your fastest path: (1) Have your cardiologist submit a PA through the UHC provider portal with your heart failure diagnosis,

How to Get Humate-P Approved by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Humate-P Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Humate-P (antihemophilic factor/vWF complex) in New York. The fastest path to approval: (1) Submit PA through the UnitedHealthcare Provider Portal with complete VWD subtype documentation and DDAVP trial results, (2) Include dosing calculations showing

Work With Your Doctor to Get Fintepla (Fenfluramine) Approved by UnitedHealthcare in Illinois: Complete Provider Collaboration Guide

Answer Box: Your Fast-Track to Fintepla Approval Getting Fintepla (fenfluramine) covered by UnitedHealthcare in Illinois requires prior authorization through OptumRx with documented Dravet syndrome or Lennox-Gastaut syndrome diagnosis, failed trials of at least two standard antiseizure medications, and completed REMS enrollment with baseline echocardiogram. Start today by calling your neurologist

Lowering Out-of-Pocket for Bylvay (Odevixibat) with UnitedHealthcare in Illinois: Copay, Tiering & Assistance

Answer Box: Getting Affordable Bylvay Coverage in Illinois Bylvay (odevixibat) costs $14,152–$44,562 per month through UnitedHealthcare in Illinois, but multiple cost-reduction strategies can bring your out-of-pocket down significantly. First step: Enroll in IPSEN CARES copay assistance (potentially $0 copay for commercial insurance) and request a benefit investigation

How to Get Qinlock (ripretinib) Covered by UnitedHealthcare in California: Forms, Appeals, and Step-by-Step Guide

Answer Box: Getting Qinlock Covered by UnitedHealthcare in California Quick Path to Approval: UnitedHealthcare requires prior authorization for Qinlock (ripretinib) in advanced GIST patients who've failed ≥3 kinase inhibitors including imatinib. Submit through the UnitedHealthcare Provider Portal with documented TKI failure history. If denied, file internal appeal within

Work With Your Doctor to Get Zolgensma Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals, and Documentation Guide

Answer Box: Get Zolgensma Covered by UnitedHealthcare in Washington Fastest path: Partner with your pediatric neurologist to submit a complete prior authorization including genetic confirmation of bi-allelic SMN1 mutation, anti-AAV9 antibody titer ≤1:50, and detailed medical necessity letter. UnitedHealthcare requires PA for all Zolgensma cases with 45-day authorization window