Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1058 issues

How to Get Ozempic and Mounjaro Covered by UnitedHealthcare in Georgia: Complete Appeal Guide with Forms and Timelines

Answer Box: Getting Ozempic/Mounjaro Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Ozempic (semaglutide) and Mounjaro (tirzepatide) with step therapy requiring metformin trials first. To get coverage: 1) Work with your doctor to document failed metformin/diabetes medications, 2) Submit PA request via OptumRx with clinical evidence,
6 min read

Work With Your Doctor to Get Synagis (Palivizumab) Approved by UnitedHealthcare in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Synagis Covered in New Jersey UnitedHealthcare requires prior authorization for Synagis (palivizumab) in high-risk pediatric patients under 24 months, with coverage limited to 5 monthly doses per RSV season. Your pediatrician must document specific criteria: prematurity (<29 weeks if under 12 months), chronic lung disease requiring
7 min read

How to Get Venclexta (venetoclax) Approved by UnitedHealthcare in Michigan: Complete Timeline, Forms & Appeals Guide

Quick Answer: Getting Venclexta Approved in Michigan UnitedHealthcare requires prior authorization for Venclexta (venetoclax) via OptumRx, with standard decisions in 72 hours and urgent approvals in 24 hours. Submit complete documentation including diagnosis confirmation, TLS monitoring plan, and step therapy evidence through the UHC provider portal. If denied, Michigan residents
6 min read

How to Get Voxzogo (vosoritide) Covered by UnitedHealthcare in Pennsylvania: 2025 Requirements, Appeals, and Documentation

Answer Box: Quick Path to Voxzogo Coverage UnitedHealthcare requires prior authorization for Voxzogo (vosoritide) in Pennsylvania. Your fastest path to approval: (1) Ensure prescription comes from a pediatric endocrinologist or geneticist, (2) Submit complete PA with FGFR3 genetic test results, open growth plate imaging, and baseline growth data via UnitedHealthcare
6 min read

How to Get Cimzia (Certolizumab Pegol) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cimzia Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Cimzia (certolizumab pegol) but approves 85.2% of appeals when properly documented. Key requirements: specialist prescription, TB/hepatitis B screening, and proof of failed conventional therapies. Submit via UHC provider portal with complete medical records.
4 min read

If Gattex (Teduglutide) Isn't Approved by UnitedHealthcare in Ohio: Formulary Alternatives & Exception Paths

Answer Box: Your Options When UnitedHealthcare Denies Gattex If UnitedHealthcare denies Gattex (teduglutide) for short bowel syndrome in Ohio, your alternatives include somatropin (growth hormone), glutamine supplementation, and optimized enteral nutrition strategies. While no other FDA-approved GLP-2 analogs exist, you can appeal the denial by documenting failed alternatives like antimotility
5 min read

Denied Tecentriq (atezolizumab) by UnitedHealthcare in Illinois? Complete Appeal Guide (2025 Forms & Timelines)

Answer Box: Getting Tecentriq (atezolizumab) Covered by UnitedHealthcare in Illinois Fastest path to approval: Submit prior authorization through UnitedHealthcare's provider portal with oncologist specialty, PD-L1 test results (≥50% tumor cells or ≥10% immune cells for NSCLC), and NCCN guideline support. If denied, request peer-to-peer review within 180 days—
6 min read

How to Get Alecensa (alectinib) Covered by UnitedHealthcare in Texas: Prior Authorization Forms, Appeals Process, and Step-by-Step Approval Guide

Answer Box: Getting Alecensa Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Alecensa (alectinib) in Texas, with the drug placed on Tier 3 (specialty) requiring clinical documentation of ALK-positive NSCLC. Your oncologist submits the PA via UHC's provider portal with ALK test results, staging, and medical
5 min read

How to Get Kymriah (Tisagenlecleucel) Covered by UnitedHealthcare in North Carolina: Prior Authorization Guide with Appeal Templates

Answer Box: Quick Path to Kymriah Coverage To get Kymriah (tisagenlecleucel) covered by UnitedHealthcare in North Carolina: Your oncologist must submit prior authorization through the UHCprovider.com portal with CD19 positivity confirmation, documented prior therapy failures, and certified treatment center verification. If denied, you have 60 days to appeal internally,
6 min read

How to Get Soliris (Eculizumab) Covered by UnitedHealthcare in Virginia: Complete Forms, Appeals, and Contact Guide

Answer Box: Getting Soliris (Eculizumab) Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Soliris (eculizumab) under the medical benefit (HCPCS J1299) with diagnosis-specific criteria including lab confirmation, failed prior therapies, and REMS compliance. Submit PA via UnitedHealthcare provider portal or fax to 1-844-403-1028. If denied, you have 180
7 min read