Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1139 issues

How to Get Zanzalintinib (XL092) Covered by UnitedHealthcare in Texas: Appeals, Compassionate Use, and Alternative Pathways

Answer Box: Getting Zanzalintinib (XL092) Covered in Texas Zanzalintinib (XL092) is investigational and typically denied by UnitedHealthcare outside clinical trials. Your fastest path: 1) Submit prior authorization with comprehensive medical necessity documentation through the UnitedHealthcare provider portal, 2) Request peer-to-peer review if denied, 3) File internal appeal within 180 days,

Do You Qualify for Brensocatib (BRINSUPRI) Coverage by UnitedHealthcare in Texas? Decision Tree & Appeal Guide

Answer Box: To get Brensocatib (BRINSUPRI) covered by UnitedHealthcare in Texas, you need: (1) confirmed non-cystic fibrosis bronchiectasis diagnosis, (2) age 12+, (3) documented trial/failure of macrolide antibiotics, and (4) prior authorization through OptumRx. Submit PA via UnitedHealthcare Provider Portal with clinical notes showing ≥2 exacerbations in the past

How to Get Emflaza (Deflazacort) Covered by UnitedHealthcare in Virginia: Complete Requirements Guide

Answer Box: Getting Emflaza Covered by UnitedHealthcare in Virginia Fast Track to Approval: UnitedHealthcare requires prior authorization for Emflaza (deflazacort) with step therapy—patients must try prednisone first unless contraindicated. Submit PA documentation including confirmed DMD diagnosis (ICD-10: G71.0), prednisone failure/intolerance records, and specialist notes through OptumRx. If

How to Get Ferriprox (Deferiprone) Approved by UnitedHealthcare in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Ferriprox Approved by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Ferriprox (deferiprone) with specific medical necessity criteria. The fastest path to approval: (1) Confirm your diagnosis of transfusional iron overload with documented ferritin >1000 ng/mL and transfusion history, (2) Submit the PA request through

Complete Guide to Getting Firazyr (Icatibant) Covered by UnitedHealthcare in Illinois: PA Forms, Appeals, and Timeline

Answer Box: Your Path to Firazyr Coverage UnitedHealthcare requires prior authorization for Firazyr (icatibant) in Illinois. To get approved: (1) Confirm HAE diagnosis with lab results (low C4, abnormal C1-INH levels), (2) Submit PA request through OptumRx with ICD-10 code D84.1 and documentation of acute attack indication, and (3)

Getting Nourianz (Istradefylline) Covered by UnitedHealthcare in Virginia: Complete Cost-Saving Guide with Appeals Templates

Answer Box: Getting Nourianz Covered by UnitedHealthcare in Virginia Nourianz (istradefylline) requires prior authorization from UnitedHealthcare and is typically placed on specialty tier (Tier 4/5) with higher copays. Virginia patients can reduce costs through Kyowa Kirin Cares copay assistance (commercial insurance only), tier exception requests, and Virginia's

How Long Does It Take to Get Kalydeco (ivacaftor) Approved by UnitedHealthcare in New York? Complete Timeline & Appeals Guide

Answer Box: Getting Kalydeco Approved by UnitedHealthcare in New York Timeline: 3-14 days for initial decision. UnitedHealthcare must respond to Kalydeco prior authorization requests within 3 business days (non-urgent) or 24 hours (urgent) under New York state law. Most approvals happen within 5-7 days when complete documentation is submitted. Required:

How Long Does It Take to Get Humate-P Approved by UnitedHealthcare in North Carolina? Complete Timeline & Approval Guide

Quick Answer: UnitedHealthcare typically processes Humate-P prior authorization requests within 7 calendar days in North Carolina, with expedited reviews in 2 business days for urgent cases. Success requires complete VWD subtype testing, documented desmopressin failure (when applicable), and proper clinical justification. Start by gathering lab results and having your provider

How to Get Luxturna (Voretigene Neparvovec-Rzyl) Covered by UnitedHealthcare in Georgia: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Luxturna Covered by UnitedHealthcare in Georgia Luxturna requires prior authorization from UnitedHealthcare with strict criteria: confirmed biallelic RPE65 mutations, viable retinal cells via OCT, and treatment at a Spark-designated center. If denied, you have 180 days for internal appeals, then 60 days for external review through Georgia&

Renewing Ibrance (Palbociclib) Approval with UnitedHealthcare in New York: Timeline, Documents & Appeals

Answer Box: Renewing Ibrance Coverage with UnitedHealthcare in New York UnitedHealthcare requires annual prior authorization renewal for Ibrance (palbociclib), issued for 12-month periods. To renew successfully: (1) Submit reauthorization 30-60 days before expiration with documentation showing no disease progression, (2) Include required CBC monitoring results and any dose modifications, (3)