Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1133 issues

UnitedHealthcare's Coverage Criteria for Upstaza (Eladocagene Exuparvovec) in Washington: What Counts as "Medically Necessary"?

Answer Box: UnitedHealthcare requires prior authorization for Upstaza (eladocagene exuparvovec) gene therapy, demanding genetic confirmation of DDC mutations, biochemical proof of AADC deficiency, and administration at a certified gene therapy center. If denied, Washington residents can appeal through internal review, then request external review through an Independent Review Organization (IRO)
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Do You Qualify for Hetlioz (Tasimelteon) Coverage by UnitedHealthcare in Virginia? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Hetlioz Coverage To get Hetlioz (tasimelteon) covered by UnitedHealthcare in Virginia, you must have a confirmed diagnosis of Non-24-Hour Sleep-Wake Disorder (with total blindness) or Smith-Magenis Syndrome, plus documented failure of melatonin therapy. The fastest approval path: (1) Have your sleep specialist complete UnitedHealthcare&
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Getting Elzonris (Tagraxofusp-erzs) Covered by UnitedHealthcare in New York: Complete Decision Tree & Appeals Guide

Answer Box: Quick Qualification Check Most patients with confirmed CD123-positive BPDCN can get Elzonris covered by UnitedHealthcare in New York. The fastest path requires: (1) Updated pathology report confirming CD123+ BPDCN, (2) Capillary leak syndrome monitoring plan documented, (3) Prior authorization submitted through OptumRx with complete clinical records. First step
6 min read

Kesimpta (Ofatumumab) Coverage by UnitedHealthcare in Florida: Prior Authorization Guide & Appeal Strategies

Quick Answer: Getting Kesimpta Covered by UnitedHealthcare in Florida Kesimpta (ofatumumab) requires prior authorization from UnitedHealthcare in Florida and typically faces step therapy requirements. To get coverage: 1) Submit prior authorization through the UHC Provider Portal with complete MS diagnosis documentation and prior DMT failure records, 2) If denied due
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How to Get Elelyso (Taliglucerase Alfa) Covered by UnitedHealthcare in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Elelyso Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Elelyso (taliglucerase alfa) and typically prefers VPRIV as first-line therapy for Type 1 Gaucher disease. Your fastest path to approval: 1. Submit PA request via UnitedHealthcare Provider Portal with confirmed Gaucher disease diagnosis (enzyme assay or
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How to Get Cresemba (Isavuconazole) Approved by UnitedHealthcare in Ohio: Complete Prior Authorization Guide

Quick Answer: Getting Cresemba Approved in Ohio Cresemba (isavuconazole) requires prior authorization from UnitedHealthcare in Ohio and follows step therapy requirements. You'll need documented invasive aspergillosis or mucormycosis diagnosis, infectious disease consultation, and proof that voriconazole failed or is contraindicated. Submit through the UnitedHealthcare Provider Portal or fax
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Renewing Soliris (Eculizumab) Approval with UnitedHealthcare in Georgia: Complete 2025 Guide to Annual Reauthorization

Answer Box: Renewing Soliris Coverage with UnitedHealthcare in Georgia UnitedHealthcare requires annual reauthorization for Soliris (eculizumab), typically 30-60 days before your current approval expires. Start the renewal process at least 6 weeks early to avoid treatment interruption. Required documents include updated specialist notes, current lab results, vaccination records, and REMS
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How to Get Tysabri (Natalizumab) Covered by UnitedHealthcare in New Jersey: Prior Authorization, Appeals & Alternatives Guide

Answer Box: Getting Tysabri Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Tysabri (natalizumab) in New Jersey, with strict documentation requirements including TOUCH program enrollment, JCV antibody testing, and MRI results. If denied, you have 180 days to file an internal appeal, followed by New Jersey'
6 min read