Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1119 issues

How to Get Galafold (Migalastat) Covered by UnitedHealthcare in New York: Decision Tree, Appeals Guide & Forms

Answer Box: Getting Galafold Covered by UnitedHealthcare in New York Quick eligibility check: You likely qualify if you have (1) confirmed Fabry disease diagnosis, (2) genetic testing showing an amenable GLA variant, and (3) aren't on severe kidney impairment (eGFR <30). Fastest path: Submit prior authorization through

How to Get Breyanzi Covered by UnitedHealthcare in Ohio: Complete Prior Authorization Guide (2025)

Answer Box: Your Fastest Path to Breyanzi Coverage Breyanzi (lisocabtagene maraleucel) requires prior authorization from UnitedHealthcare in Ohio. Your oncologist must submit clinical documentation showing you meet FDA-approved criteria for relapsed/refractory large B-cell lymphoma (≥2 prior lines) or CLL/SLL (after BTK and BCL-2 inhibitor failure). Standard review takes

ICD-10 Codes and Billing Guide: Getting Xenpozyme Covered by UnitedHealthcare in Florida

Answer Box: Getting Xenpozyme Covered by UnitedHealthcare in Florida Quick Path to Approval: Xenpozyme requires prior authorization through UnitedHealthcare with specific ICD-10 codes (E75.240-E75.244), genetic testing confirmation, and medical benefit billing. Submit via OptumRx at 1-833-547-2030 with complete clinical documentation including ASMD diagnosis confirmation, baseline spleen imaging, and

Do You Qualify for Sylvant (Siltuximab) Coverage by UnitedHealthcare in Michigan? Complete Decision Tree & Appeals Guide

Answer Box: Your Path to Sylvant Coverage in Michigan Quick eligibility check: You likely qualify for Sylvant (siltuximab) coverage if you have confirmed idiopathic multicentric Castleman disease (iMCD), are HIV-negative and HHV-8-negative, and meet basic lab thresholds. UnitedHealthcare requires prior authorization through their provider portal, typically taking 1-5 business days.

Getting Pombiliti (Cipaglucosidase Alfa-atga) Covered by UnitedHealthcare in Virginia: Complete Appeals Guide

Quick Answer: Your Path to Pombiliti Coverage in Virginia If UnitedHealthcare denied your Pombiliti (cipaglucosidase alfa-atga) prescription, you have strong appeal rights in Virginia. First step: Request a peer-to-peer review within 24 hours of denial. Second step: File an internal appeal within 180 days. Final step: Submit Form 216-A to

How to Get Pomalyst (Pomalidomide) Covered by UnitedHealthcare in Illinois: Complete PA Guide with Appeal Forms and Timelines

Answer Box: Getting Pomalyst Covered by UnitedHealthcare in Illinois Fastest Path to Approval: Pomalyst (pomalidomide) requires prior authorization from UnitedHealthcare. Your oncologist must submit clinical documentation showing you've tried and failed both lenalidomide and a proteasome inhibitor, with disease progression within 60 days of last therapy. Illinois banned

If Darzalex Isn't Approved by UnitedHealthcare in Washington: Formulary Alternatives & Exception Paths

Answer Box: When Darzalex Isn't Your First Option If UnitedHealthcare denies Darzalex (daratumumab) in Washington, you have proven alternatives and exception paths. Fastest approach: Try formulary alternatives like Sarclisa (isatuximab) or proteasome inhibitors first, document response/failure thoroughly, then request a Darzalex exception with clinical evidence. Start today:

How to Get Sylvant (Siltuximab) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Sylvant Covered by UnitedHealthcare in New Jersey Sylvant (siltuximab) requires mandatory prior authorization from UnitedHealthcare for multicentric Castleman disease. Your oncologist submits the PA request through the UnitedHealthcare Provider Portal with HIV-negative/HHV-8-negative test results, complete pathology report, and clinical documentation. If denied, you have 180 days

UnitedHealthcare's Coverage Criteria for Kuvan (Sapropterin) in California: Complete Prior Authorization Guide 2025

Answer Box: Getting Kuvan Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Kuvan (sapropterin dihydrochloride) with specific criteria: confirmed PKU diagnosis, active phenylalanine-restricted diet, and no concurrent Palynziq use. Submit through the UnitedHealthcare Provider Portal or call 866-889-8054. If denied, California residents can file a free Independent Medical

How to Get Elaprase (Idursulfase) Covered by UnitedHealthcare in Texas: Forms, Appeals, and Step-by-Step Guide

Answer Box: Quick Path to Elaprase Coverage Getting Elaprase (idursulfase) covered by UnitedHealthcare in Texas requires prior authorization through OptumRx. Submit your PA request via the UnitedHealthcare Provider Portal or fax to 1-844-403-1027. Include genetic/enzymatic confirmation of Hunter syndrome (MPS II), weight-based dosing calculations (0.5 mg/kg weekly)