Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1118 issues

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
7 min read

If Filspari (sparsentan) Isn't Approved by UnitedHealthcare in Georgia: Formulary Alternatives & Exception Paths

Answer Box: When UnitedHealthcare Denies Filspari (sparsentan) in Georgia If UnitedHealthcare denies Filspari (sparsentan) for IgA nephropathy in Georgia, you have three main paths: 1) Try the preferred alternative Vanrafia (atrasentan) if clinically appropriate, 2) Request a medical exception citing contraindications to alternatives, or 3) Appeal the denial with additional
6 min read

How to Get Juxtapid (Lomitapide) Covered by UnitedHealthcare in Georgia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Juxtapid Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Juxtapid (lomitapide) with strict criteria for homozygous familial hypercholesterolemia (HoFH). You'll need genetic confirmation or untreated LDL-C >400 mg/dL, documented failure of PCSK9 inhibitors and other lipid-lowering therapies, and a specialist prescriber.
5 min read

How to Get Vanflyta (Quizartinib) Covered by UnitedHealthcare in Virginia: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Vanflyta Covered by UnitedHealthcare in Virginia Vanflyta (quizartinib) requires prior authorization from UnitedHealthcare for FLT3-ITD positive AML. The fastest path to approval: (1) Submit complete PA with FLT3-ITD test results, baseline EKG showing QTc ≤450ms, and medical necessity letter addressing step therapy, (2) If denied, file internal
6 min read

Myths vs. Facts: Getting Aldurazyme (laronidase) Covered by UnitedHealthcare in North Carolina

Answer Box: Getting Aldurazyme Covered by UnitedHealthcare in North Carolina Eligibility: UnitedHealthcare requires prior authorization for Aldurazyme (laronidase) with confirmed MPS I diagnosis through enzymatic testing and genetic confirmation. Fastest path: Have your MPS specialist submit complete PA documentation including IDUA enzyme deficiency results, genetic testing, and baseline clinical assessments.
5 min read

How to Get Luxturna Covered by UnitedHealthcare in New York: Complete Timeline, Appeals Guide & Required Documentation

Quick Answer: UnitedHealthcare requires prior authorization for Luxturna (voretigene neparvovec-rzyl) in New York with biallelic RPE65 genetic testing, OCT showing retinal viability, and treatment at certified centers. Standard PA decisions take 3-15 business days; expedited reviews within 72 hours. If denied, New York offers binding external appeals through the Department
6 min read

How Long Does It Take to Get Strensiq (asfotase alfa) Approved by UnitedHealthcare in Washington? Complete Timeline & Appeals Guide

Answer Box: Getting Strensiq Approved by UnitedHealthcare in Washington UnitedHealthcare typically takes 15-30 days to decide on Strensiq (asfotase alfa) prior authorization for pediatric-onset hypophosphatasia, with expedited decisions in 24-72 hours for urgent cases. Washington residents have strong appeal rights, including binding external review by an Independent Review Organization (IRO)
6 min read

UnitedHealthcare's Coverage Criteria for Kanuma (Sebelipase Alfa) in Ohio: What Counts as "Medically Necessary"?

Answer Box: Getting Kanuma Covered by UnitedHealthcare in Ohio UnitedHealthcare covers Kanuma (sebelipase alfa) for lysosomal acid lipase deficiency (LAL-D) with prior authorization required. To qualify, you need: confirmed LAL-D diagnosis (enzyme deficiency or LIPA gene variants), documented hepatic abnormalities (elevated ALT/AST, hepatomegaly), and evidence of failed supportive therapy
7 min read