Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1121 issues

How to Get Opfolda (Miglustat) Covered by UnitedHealthcare in Georgia: Complete Timeline, Appeals Guide, and Patient Support

Answer Box: To get Opfolda (miglustat) covered by UnitedHealthcare in Georgia, you must submit prior authorization for both Opfolda AND Pombiliti simultaneously—Opfolda is only approved in combination. Standard review takes 72 hours for complete submissions. Key requirements: confirmed late-onset Pompe disease diagnosis, documented inadequate response to current enzyme replacement

Work With Your Doctor to Get Prolastin-C Approved by UnitedHealthcare in New Jersey: Provider Partnership Guide

Answer Box: Your Partnership Path to Prolastin-C Approval Getting Prolastin-C covered by UnitedHealthcare in New Jersey requires strong collaboration with your doctor. You need documented severe alpha-1 antitrypsin deficiency (Pi*ZZ genotype), emphysema evidence, and failed step therapy alternatives. Your fastest path: (1) Schedule a pre-authorization visit to gather all

Getting Hemgenix (etranacogene dezaparvovec) Approved by UnitedHealthcare in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: How to Get Hemgenix Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Hemgenix (etranacogene dezaparvovec) with strict clinical criteria: 50+ Factor IX exposure days, no inhibitors, adult status, and normal liver function. Step 1: Submit PA through the UnitedHealthcare Provider Portal with comprehensive documentation from a

Myths vs. Facts: Getting Retevmo (Selpercatinib) Covered by UnitedHealthcare in California

Answer Box: Getting Retevmo Covered by UnitedHealthcare in California The fastest path to Retevmo approval: Submit prior authorization with FDA-approved RET testing results, complete treatment history, and clinical necessity documentation. If denied, file an expedited internal appeal within 21 days, then request California DMHC Independent Medical Review (73% success rate)

How to Get Dojolvi (Triheptanoin) Covered by UnitedHealthcare in Illinois: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Dojolvi Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of LC-FAOD and discontinuation of MCT oil. If denied, Illinois residents have strong appeal rights including internal appeals (180 days) and external review (4 months from final denial). Start today: 1)

The Complete Requirements Checklist to Get Firdapse (Amifampridine) Covered by UnitedHealthcare in Ohio: Forms, Appeals, and Approval Tips

Quick Answer: Getting Firdapse Covered by UnitedHealthcare in Ohio Yes, UnitedHealthcare covers Firdapse (amifampridine) for Lambert-Eaton myasthenic syndrome (LEMS) with prior authorization. The fastest path to approval requires: (1) confirmed LEMS diagnosis from a neurologist with EMG and antibody testing, (2) complete OptumRx prior authorization form with clinical documentation, and

How to Get Ofev (Nintedanib) Covered by UnitedHealthcare in California: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Ofev Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Ofev (nintedanib) across all California plans, with strict clinical criteria including pulmonologist evaluation, HRCT confirmation of fibrosis, and documented disease progression. If denied, California's Independent Medical Review (IMR) system provides binding external review with

How to Get Skyrizi (Risankizumab) Covered by UnitedHealthcare in New Jersey: Prior Authorization Guide with Appeals Process

Answer Box: Getting Skyrizi Covered by UnitedHealthcare in New Jersey Quick Path to Approval: Skyrizi (risankizumab) requires prior authorization from UnitedHealthcare. You'll need documented failure of topical treatments (for psoriasis) or TNF inhibitors like Humira (for psoriatic arthritis/IBD), plus tuberculosis screening. If denied, New Jersey's

How to Get Qalsody (Tofersen) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Qalsody Covered by UnitedHealthcare in California Qalsody (tofersen) requires prior authorization through UnitedHealthcare's OptumRx with strict documentation requirements. You'll need genetic confirmation of SOD1 mutation, neurologist involvement, baseline ALSFRS-R scores, and evidence of riluzole/edaravone trial or contraindication. Submit via the UnitedHealthcare provider

How to Get Photrexa Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Photrexa Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Photrexa (riboflavin ophthalmic solution) corneal cross-linking in Ohio. Coverage is limited to FDA-approved epithelium-off iLink® procedures for progressive keratoconus with documented worsening (≥1 diopter Kmax increase over 12 months). First step: Have your ophthalmologist submit a