Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1123 issues

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

Quick Answer: Getting Rinvoq Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Rinvoq (upadacitinib) with mandatory step therapy—you must first try and fail at least one TNF inhibitor biologic. To get approval: (1) Your doctor documents your qualifying diagnosis and failed TNF inhibitor trial, (2) Complete required
6 min read

How to Get Tagrisso (osimertinib) Covered by UnitedHealthcare in Georgia: Prior Authorization Guide, Appeal Steps, and External Review

Answer Box: Getting Tagrisso Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Tagrisso (osimertinib) in Georgia. To get approval: (1) Submit documented proof of EGFR mutation-positive NSCLC, (2) Complete the UnitedHealthcare PA form with clinical notes showing disease stage and treatment history, (3) If denied, file internal appeal
6 min read

How Long Does It Take to Get Prolastin-C Approved by UnitedHealthcare in New York? Complete Timeline & Appeals Guide

Answer Box: Getting Prolastin-C Approved by UnitedHealthcare in New York Timeline: Standard prior authorization decisions take 72 hours; expedited requests get 24-hour turnaround. Requirements: Pi*ZZ genotype confirmation, lung function tests showing impairment, and often trial/failure of preferred alternatives (Aralast NP, Glassia, Zemaira). First step: Gather complete documentation and
5 min read

How to Get Imbruvica (ibrutinib) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Imbruvica Covered by UnitedHealthcare in North Carolina Most UnitedHealthcare members in North Carolina can get Imbruvica (ibrutinib) covered through OptumRx's prior authorization process. The key steps: verify your diagnosis meets medical necessity criteria (CLL, SLL, or Waldenström macroglobulinemia), gather comprehensive clinical documentation, and submit the
7 min read

How to Get Xospata (gilteritinib) Covered by UnitedHealthcare in Michigan: Forms, Appeals & Step-by-Step Guide

Answer Box: Getting Xospata Approved by UnitedHealthcare in Michigan Xospata (gilteritinib) requires prior authorization through OptumRx for UnitedHealthcare members in Michigan. Your oncologist must submit clinical documentation proving FLT3-mutated relapsed/refractory AML diagnosis, prior therapy history, and medical necessity via the UnitedHealthcare Provider Portal or by calling 1-800-711-4555. If denied,
6 min read

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by UnitedHealthcare in California: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Lutathera Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Lutathera (lutetium Lu-177 dotatate) with step therapy documentation showing progression on somatostatin analogs. The fastest path to approval involves: 1. Submit PA request through the UnitedHealthcare Provider Portal with SSTR-positive imaging (Ga-68 DOTATATE PET/CT), pathology
6 min read

UnitedHealthcare's Coverage Criteria for Nucala (mepolizumab) in Texas: What Counts as "Medically Necessary"?

Answer Box: Getting Nucala Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Nucala (mepolizumab) with specific criteria: eosinophil count ≥150 cells/µL (or ≥300 cells/µL in past year) for severe asthma, documented failure of high-dose inhaled therapy, and specialist involvement. Fastest path: Submit PA through UnitedHealthcare Provider
6 min read

Complete Guide to Getting Sylvant (Siltuximab) Covered by UnitedHealthcare in California: Prior Authorization, Appeals, and Success Strategies

Answer Box: Getting Sylvant Covered by UnitedHealthcare in California Fastest path to approval: Submit prior authorization through the UnitedHealthcare Provider Portal with complete documentation: confirmed iMCD diagnosis (ICD-10 D47.Z2), HIV-negative and HHV-8-negative lab results, pathology reports, and evidence of step therapy completion or contraindication. Standard approval takes 1-5 business
5 min read

Resources to Get Vyondys 53 (golodirsen) Approved with UnitedHealthcare in Washington: Forms, Portals & Contacts

Answer Box: Getting Vyondys 53 Covered by UnitedHealthcare in Washington Quick Path to Approval: UnitedHealthcare requires prior authorization for Vyondys 53 (golodirsen) with strict genetic documentation and ambulatory status requirements. Submit through the UnitedHealthcare Provider Portal with complete DMD genetic testing, functional assessments (NSAA >17 or TTR <7
6 min read