Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1119 issues

How to Renew and Keep Ocrevus (Ocrelizumab) Coverage with UnitedHealthcare in Pennsylvania: Timeline, Documentation, and Appeals

Answer Box: Renewing Ocrevus Coverage with UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization renewal for Ocrevus (ocrelizumab) annually. Start the renewal process 4-6 weeks before your current authorization expires to avoid treatment gaps. Submit documentation showing clinical response (reduced relapses, stable MRI, improved function) through the UnitedHealthcare Provider Portal. If

How to Get Chenodal (Chenodiol) Covered by UnitedHealthcare in New York: Complete Guide with Forms, Appeals, and Step-by-Step Process

Answer Box: Getting Chenodal (Chenodiol) Covered by UnitedHealthcare in New York Current Coverage Status: UnitedHealthcare requires prior authorization for Chenodal (chenodiol) but coverage is now restricted to cerebrotendinous xanthomatosis (CTX) only. Gallstone dissolution is no longer a covered indication. Fastest Path to Approval: 1. Confirm CTX diagnosis with genetic testing

How to Get Stelara (Ustekinumab) Covered by UnitedHealthcare in Ohio: Prior Authorization Guide, Appeal Forms, and Timeline

Quick Answer: Getting Stelara Covered by UnitedHealthcare in Ohio Fastest path to approval: Submit prior authorization through UHC's provider portal with documented moderate-to-severe disease, prior therapy failures (including preferred biosimilars), and recent TB screening. If denied, file internal appeal within 180 days, then Ohio external review if needed.

How to Get Natpara (Parathyroid Hormone) Approved by UnitedHealthcare in North Carolina: Complete Timeline & Appeals Guide

Answer Box: Getting Natpara Approved by UnitedHealthcare in North Carolina Important Update: Takeda permanently discontinued Natpara manufacturing in December 2024, with the Special Use Program ending December 31, 2025. New patient approvals are extremely unlikely due to lack of commercial supply. For existing patients: UnitedHealthcare typically requires 1-15 business days

Do You Qualify for Entresto Coverage by UnitedHealthcare in Michigan? Complete Decision Tree & Appeals Guide

Answer Box: Your Fast Track to Entresto Coverage in Michigan Most likely to qualify: Heart failure patients with LVEF ≤40%, NYHA Class II-IV symptoms, prior ACE inhibitor/ARB trial (or documented intolerance), and cardiology involvement. First step today: Gather your recent echocardiogram report and medication history, then have your cardiologist

How Long Does It Take to Get Xyrem (Sodium Oxybate) Approved by UnitedHealthcare in North Carolina? Complete Timeline & Appeals Guide

Quick Answer: Xyrem Approval Timeline in North Carolina Getting Xyrem (sodium oxybate) approved by UnitedHealthcare in North Carolina typically takes 1-15 business days for the prior authorization decision, plus 1-3 days for REMS enrollment. The fastest path: ensure both you and your prescriber complete REMS enrollment first, then have your

Myths vs. Facts: Getting Opsumit (Macitentan) Covered by UnitedHealthcare in Michigan - Appeals, Forms & Timelines

Answer Box: Getting Opsumit Covered by UnitedHealthcare in Michigan Eligibility: UnitedHealthcare requires prior authorization for Opsumit (macitentan) with documented WHO Group 1 PAH, functional class II-IV, and right heart catheterization results. Fastest path: Submit PA through OptumRx with complete hemodynamic data, pregnancy testing documentation, and PAH specialist letter. If denied,

Do You Qualify for Jynarque (Tolvaptan) Coverage by UnitedHealthcare in Illinois? Decision Tree & Next Steps

Answer Box: UnitedHealthcare requires prior authorization for Jynarque (tolvaptan) but no step therapy for ADPKD. You need: confirmed ADPKD diagnosis, evidence of rapid progression (Mayo class 1C-1E or eGFR decline ≥3 mL/min/1.73m²/year), and REMS enrollment. Submit via OptumRx provider portal with clinical documentation. If denied, Illinois

Renewing Vimizim (Elosulfase Alfa) Approval with UnitedHealthcare in New Jersey: Timeline, Documentation, and Renewal Requirements

Answer Box: Renewing Vimizim Coverage with UnitedHealthcare in New Jersey UnitedHealthcare requires annual prior authorization renewal for Vimizim (elosulfase alfa) in New Jersey. Start the renewal process 30 days before your current approval expires. Your metabolic specialist must submit updated documentation showing continued benefit through the UHC Provider Portal, including

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

Answer Box: Fast Facts for California Patients UnitedHealthcare requires prior authorization for Naglazyme (galsulfase) in California. Success depends on complete diagnostic documentation (enzyme assay + genetic testing), specialist involvement, and baseline functional assessments. If denied, California's Independent Medical Review (IMR) overturns 55-70% of medical necessity denials. First step: Have