Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1130 issues

Lowering Out-of-Pocket for Thiola / Thiola EC (tiopronin) with UnitedHealthcare in California: Copay, Tiering & Assistance

Answer Box: Getting Thiola Covered by UnitedHealthcare in California Fastest path to approval: UnitedHealthcare requires prior authorization for Thiola/Thiola EC with documented cystinuria diagnosis (ICD-10 E72.01), 24-hour urine cystine >250mg/day, specialist involvement, and failed conservative therapy. Submit through OptumRx portal with complete clinical documentation. If denied,
6 min read

How to Get Idelvion (Albutrepenonacog Alfa) Covered by UnitedHealthcare in New York: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Idelvion Covered by UnitedHealthcare in New York Yes, UnitedHealthcare covers Idelvion (albutrepenonacog alfa) in New York, but requires prior authorization and often step therapy. The fastest path: Have your hematologist submit a PA request through the UnitedHealthcare Provider Portal using ICD-10 code D67 and HCPCS code J7202,
6 min read

Renewing Busulfex (Busulfan Injection) Approval with UnitedHealthcare in Washington: Complete Timeline & Documentation Guide

Answer Box: To renew Busulfex (busulfan injection) approval with UnitedHealthcare in Washington, start the prior authorization process 3-4 weeks before your next treatment cycle. Submit updated clinical documentation through the UnitedHealthcare Provider Portal, including recent labs, treatment response data, and therapeutic drug monitoring results. If denied, file an internal appeal
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Work With Your Doctor to Get Bylvay (odevixibat) Approved by UnitedHealthcare in Florida: Provider Partnership Guide

Answer Box: Getting Bylvay Covered by UnitedHealthcare in Florida Bylvay (odevixibat) requires prior authorization through UnitedHealthcare and OptumRx for PFIC and Alagille syndrome. Your gastroenterologist or hepatologist must submit comprehensive documentation including genetic diagnosis, moderate-to-severe pruritus evidence, and proof of failure with at least two conventional treatments (like ursodeoxycholic acid
7 min read

How to Get Elzonris (Tagraxofusp-erzs) Covered by UnitedHealthcare in Virginia: Complete PA Guide and Appeals Process

Answer Box: Quick Path to Coverage To get Elzonris (tagraxofusp-erzs) covered by UnitedHealthcare in Virginia: You need confirmed CD123-positive BPDCN diagnosis, baseline labs showing albumin ≥3.2 g/dL, and a detailed capillary leak syndrome monitoring plan. Submit prior authorization through the UnitedHealthcare Provider Portal with pathology report, clinical notes,
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UnitedHealthcare's Coverage Criteria for Poteligeo (mogamulizumab-kpkc) in Illinois: What Counts as "Medically Necessary"?

Answer Box: Getting Poteligeo Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Poteligeo (mogamulizumab-kpkc) with documented mycosis fungoides/Sézary syndrome, failure of ≥1 prior systemic therapy, and prescriber specialty (oncology/dermatology). Fastest path to approval: 1. Gather complete TNMB staging documentation and prior therapy records 2. Submit PA
6 min read