Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1121 issues

How to Get Kalydeco (ivacaftor) Covered by UnitedHealthcare in Georgia: Complete Coding, Prior Authorization & Appeals Guide

Answer Box: Getting Kalydeco Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Kalydeco (ivacaftor) in Georgia, but no step therapy is required for patients with ivacaftor-responsive CFTR mutations. Approval depends on proper coding and complete genetic documentation. Three steps to approval: 1. Submit genetic test results showing FDA-approved

How Long Does It Take to Get Hetlioz LQ Approved by UnitedHealthcare in Texas? Complete Timeline Guide

Answer Box: Getting Hetlioz LQ Approved by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) in Texas, with standard approval taking 72 hours for complete submissions. For pediatric Smith-Magenis syndrome patients aged 3-15, you'll need genetic confirmation, documented sleep disturbances, and proof of

Sylvant (Siltuximab) Coverage by UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Sylvant Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Sylvant (siltuximab) in Florida. The fastest path to approval: (1) Gather HIV-negative and HHV-8-negative lab results, pathology confirming multicentric Castleman disease, and clinical notes; (2) Submit PA through the UnitedHealthcare Provider Portal with complete documentation; (3)

How to Get Garadacimab (Andembry) Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide

Quick Answer: To get Garadacimab (Andembry) covered by UnitedHealthcare in Ohio, you'll need prior authorization through OptumRx with documented HAE diagnosis and step therapy compliance. If denied, Ohio allows two internal appeals plus external review within 180 days. Start by gathering your HAE diagnosis confirmation, prior therapy records,

How to Get Qinlock (ripretinib) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Qinlock Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Qinlock (ripretinib) as a fourth-line GIST treatment after documented failure of imatinib, sunitinib, and regorafenib. Your oncologist must submit clinical documentation proving prior therapy failures through OptumRx specialty pharmacy. If denied, you have 180 days for

How to Get Uplizna (inebilizumab) Covered by UnitedHealthcare in Georgia: Coding, Appeals, and Prior Authorization Guide

Quick Answer: Getting Uplizna Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Uplizna (inebilizumab) in Georgia with step therapy requirements. For NMOSD patients, document AQP4-IgG positivity and rituximab failure. For IgG4-RD patients, show glucocorticoid inadequacy. Use ICD-10 code G36.0 (NMOSD) or D89.84 (IgG4-RD), HCPCS J1823, and

Myths vs. Facts: Getting Trikafta Covered by UnitedHealthcare in Florida (Complete Appeals Guide with Forms and Timelines)

Answer Box: Getting Trikafta Covered by UnitedHealthcare in Florida Key Facts: UnitedHealthcare covers Trikafta for CF patients aged 2+ with documented F508del or responsive CFTR mutations. Prior authorization is required through OptumRx specialty pharmacy network. First step: Verify your genetic test results are complete and contact your CF specialist to

How to Get Myozyme (Alglucosidase Alfa) Covered by UnitedHealthcare in Florida: Complete Appeals Guide with Forms and Timelines

Quick Answer: UnitedHealthcare requires prior authorization for Myozyme (alglucosidase alfa) in Florida through OptumRx. Success requires confirmed Pompe disease diagnosis (genetic testing + enzyme deficiency), specialist evaluation, and complete clinical documentation. If denied, Florida law provides 180 days for internal appeals and external review through the Department of Financial Services. Start

How to Get Entresto (Sacubitril/Valsartan) Covered by UnitedHealthcare in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Entresto Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Entresto (sacubitril/valsartan) with specific heart failure criteria and ACE inhibitor/ARB trial documentation. Your fastest path to approval: 1. Gather required documents: Recent echocardiogram showing LVEF ≤40%, heart failure diagnosis with ICD-10 code, and documentation

How to Get Carbaglu (Carglumic Acid) Covered by UnitedHealthcare in New York: Complete PA Guide with Appeals Process

Answer Box: Getting Carbaglu Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Carbaglu (carglumic acid) with 12-month approval periods. Key requirements: genetic confirmation of NAGS deficiency, elevated ammonia levels, and specialist documentation. If denied, New York residents can file internal appeals (180 days) then external review through