Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1133 issues

How to Get Gattex (Teduglutide) Covered by UnitedHealthcare in Virginia: Appeals, Forms, and Provider Scripts

Answer Box: Getting Gattex Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Gattex (teduglutide) with specific medical necessity criteria. Patients need documented Short Bowel Syndrome, current parenteral nutrition dependency (≥12 months for adults, ≥3 months for pediatrics), and recent colonoscopy results. If denied, Virginia offers a robust external
6 min read

How to Get Krystexxa (Pegloticase) Covered by UnitedHealthcare in New York: Complete Guide to Prior Authorization, Appeals, and Alternatives

Answer Box: Getting Krystexxa Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Krystexxa (pegloticase) with strict step therapy requirements. You must document failed trials of allopurinol and febuxostat, plus G6PD testing and rheumatologist oversight. If denied, New York offers strong external appeal rights through the Department of
5 min read

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by UnitedHealthcare in Ohio: Complete Appeals Guide with Templates

Answer Box: Getting Lutathera Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Lutathera (lutetium Lu-177 dotatate) with mandatory step therapy documentation showing progression on somatostatin analogs. In Ohio, you have 60 days to appeal denials internally, then 180 days for external review through the Ohio Department of Insurance.
6 min read

How to Get Haegarda (C1-esterase inhibitor, SC) Covered by UnitedHealthcare in Georgia: Appeals, Alternatives & Step Therapy Exceptions

Answer Box: Getting Haegarda Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Haegarda (C1-esterase inhibitor, SC) in Georgia. The fastest path to approval: 1) Have your doctor submit a PA request with HAE diagnosis confirmation (C1-INH levels, ICD-10 D84.1) and attack history documentation, 2) If denied, request
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Renewing Cystadane (Betaine Anhydrous) Approval with UnitedHealthcare in Florida: Timeline, Documents, and Bridge Options

Answer Box: Renewing Cystadane Coverage with UnitedHealthcare in Florida Cystadane (betaine anhydrous) requires annual or bi-annual prior authorization renewal with UnitedHealthcare in Florida. Start the renewal process 60-90 days before your current approval expires. Your provider must submit updated clinical documentation including recent homocysteine levels, treatment response data, and continued
5 min read

Renewing Blenrep (Belantamab Mafodotin) Approval with UnitedHealthcare in Pennsylvania: Timeline, Documents & Appeal Process

Quick Answer: Blenrep Renewal with UnitedHealthcare in Pennsylvania Current Status: Blenrep (belantamab mafodotin) was withdrawn from the U.S. market in 2022 and is only available through clinical trials or expanded access programs. UnitedHealthcare typically denies coverage outside these settings. For trial-related bridge therapy or expanded access, submit prior authorization
5 min read

Renewing Elelyso (Taliglucerase Alfa) Approval with UnitedHealthcare in Illinois: Annual Requirements and Timeline

Answer Box: Elelyso Renewal with UnitedHealthcare in Illinois Quick Answer: Elelyso (taliglucerase alfa) requires annual prior authorization renewal with UnitedHealthcare, typically 30-60 days before expiration. Submit updated clinical documentation showing continued response to therapy, including current labs, specialist notes, and treatment monitoring results. Start the renewal process early through the
5 min read

How to Get Filsuvez (Birch Triterpenes Gel) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Filsuvez Covered by UnitedHealthcare in North Carolina Filsuvez requires prior authorization from UnitedHealthcare/OptumRx for epidermolysis bullosa wound care. To get approval in North Carolina: 1) Gather genetic testing confirming dystrophic or junctional EB, wound documentation, and specialist evaluation, 2) Submit PA request via UnitedHealthcare provider portal
6 min read