Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1130 issues

Getting Aldurazyme (Laronidase) Covered by UnitedHealthcare in New York: Complete Coding and Appeals Guide

Answer Box: Getting Aldurazyme Covered by UnitedHealthcare in New York Aldurazyme (laronidase) requires prior authorization from UnitedHealthcare for mucopolysaccharidosis I (MPS I) treatment. Three-step fast track: 1) Gather genetic/enzymatic confirmation of MPS I diagnosis with ICD-10 codes E76.01-E76.03, 2) Submit PA using HCPCS J1931 with precise dosing

How Long Does It Take to Get Brensocatib (BRINSUPRI) Approved by UnitedHealthcare in Washington? Timeline & Appeal Guide

Quick Answer: Brensocatib (BRINSUPRI) Approval Timeline for UnitedHealthcare in Washington Standard timeline: 1-5 business days for prior authorization decisions once complete documentation is submitted. UnitedHealthcare requires prior authorization for Brensocatib with step therapy requirements (macrolide trial, airway clearance therapy). Expedited requests: 48-72 hours for life-threatening conditions. First step today: Gather

Getting Rylaze Covered by UnitedHealthcare in Virginia: Prior Authorization Guide and Appeal Process

Answer Box: Getting Rylaze Approved by UnitedHealthcare in Virginia Rylaze requires prior authorization from UnitedHealthcare with documented hypersensitivity to E. coli asparaginase. Key requirements: ALL/LBL diagnosis, oncologist prescription, evidence of allergic reaction to pegaspargase or similar drugs. First step today: Have your oncologist gather hypersensitivity documentation and submit PA

How to Get Tremfya (Guselkumab) Covered by UnitedHealthcare in New Jersey: Prior Authorization Guide and Appeal Process

Answer Box: Getting Tremfya Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Tremfya (guselkumab) with step therapy involving TNF inhibitors for psoriasis/psoriatic arthritis and documented biologic failure for IBD. Your fastest path to approval: 1. Submit complete PA documentation including diagnosis codes, disease severity assessment, TB

Arikayce Coverage with UnitedHealthcare in California: Complete Guide to Prior Authorization, Appeals, and Approval Timeline

Answer Box: Getting Arikayce Covered by UnitedHealthcare in California Arikayce requires prior authorization from UnitedHealthcare through OptumRx. To qualify, you must have refractory MAC lung disease with positive cultures after at least 6 months of combination therapy (macrolide + ethambutol + rifamycin). Your fastest path: Have your pulmonologist or infectious disease specialist

UnitedHealthcare's Coverage Criteria for Tagrisso in Ohio: What Counts as "Medically Necessary"?

Answer Box: Getting Tagrisso Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Tagrisso (osimertinib) based on documented EGFR mutation and NSCLC diagnosis. Your fastest path to approval: 1) Gather EGFR mutation test results from FDA-approved lab, 2) Have oncologist submit PA via UnitedHealthcare Provider Portal, 3) If denied,

How to Get Signifor LAR (Pasireotide) Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Signifor LAR Approved in Ohio UnitedHealthcare requires prior authorization for Signifor LAR (pasireotide) with specific criteria: confirmed endogenous Cushing's disease and documentation that pituitary surgery wasn't curative or isn't an option. No step therapy required. If denied, you have 180 days

How Long Does It Take to Get Enbrel (etanercept) Approved by UnitedHealthcare in California? Complete Timeline & Milestones

Answer Box: Quick Timeline Overview Getting Enbrel (etanercept) approved by UnitedHealthcare in California typically takes 3-14 days for standard requests, 24-72 hours for urgent cases. The fastest path requires complete documentation upfront: diagnosis, failed DMARD trials, and specialist prescription. Start by having your rheumatologist submit the prior authorization through UnitedHealthcare&

Myths vs. Facts: Getting Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in Texas - Appeals Guide

Quick Answer: Your Path to Exondys 51 Coverage in Texas Myth: If your neurologist prescribes Exondys 51, UnitedHealthcare automatically covers it. Fact: Prior authorization is mandatory, requiring genetic proof of exon 51-amenable DMD mutation, specialist prescriber credentials, and functional assessments (6-minute walk test ≥300 meters or equivalent). Most denials stem

Do You Qualify for Xywav Coverage by UnitedHealthcare in New York? Decision Tree & Appeals Guide

Quick Answer: Getting Xywav Covered by UnitedHealthcare in New York Eligibility: You likely qualify if you have narcolepsy (type 1 or 2) or idiopathic hypersomnia with documented sleep study results, are enrolled in the REMS program, and have tried required step therapy medications. Fastest path: Submit prior authorization through OptumRx