Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1139 issues

How to Get Xywav Covered by UnitedHealthcare in Texas: Prior Authorization Guide & Appeal Scripts

Answer Box: Getting Xywav Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Xywav (Ca/Mg/K/Na oxybates) across all Texas plans. Fastest path to approval: Have your sleep specialist submit PA documentation including sleep study results, failed trials of modafinil/armodafinil, and REMS enrollment. If denied, file

How to Get Oxlumo (Lumasiran) Covered by UnitedHealthcare in Texas: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Oxlumo Covered by UnitedHealthcare in Texas Oxlumo (lumasiran) requires prior authorization from UnitedHealthcare for primary hyperoxaluria type 1 (PH1). No step therapy is required—approval focuses on confirmed PH1 diagnosis and specialist prescribing. The fastest path: (1) Ensure genetic testing confirms AGXT mutations, (2) Have a nephrologist

Work With Your Doctor to Get Alecensa (Alectinib) Approved by UnitedHealthcare in Pennsylvania: Forms, Appeals, and Success Strategies

Answer Box: Getting Alecensa Covered by UnitedHealthcare in Pennsylvania Getting Alecensa (alectinib) approved by UnitedHealthcare requires prior authorization with ALK-positive test results and clinical documentation. The fastest path: 1) Gather ALK fusion test results and treatment history, 2) Have your oncologist submit a medical necessity letter via UnitedHealthcare's

How to Get Palynziq (pegvaliase-pqpz) Covered by UnitedHealthcare in Washington: ICD-10, HCPCS Codes & Appeal Guide

Answer Box: Getting Palynziq Covered by UnitedHealthcare in Washington Fastest path to approval: Submit prior authorization with ICD-10 code E70.0 (classical PKU), blood phenylalanine >600 µmol/L, proof of Phe-restricted diet, and documentation of sapropterin failure/contraindication. Use HCPCS J3590 for billing. If denied, file internal appeal within

How to Get Mavenclad (Cladribine) Covered by UnitedHealthcare in California: Complete Prior Authorization Guide with Appeal Scripts

Answer Box: Get Mavenclad Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Mavenclad (cladribine) in California through OptumRx. You'll need: confirmed relapsing MS diagnosis, documented failure of at least one other DMT, normal lymphocyte counts, and no pregnancy/malignancy. Submit via the UnitedHealthcare Provider Portal with

Resources to Get Hetlioz LQ (tasimelteon) Approved with UnitedHealthcare in Georgia: Forms, Portals & Appeals Guide

Answer Box: Getting Hetlioz LQ Covered by UnitedHealthcare in Georgia Hetlioz LQ (tasimelteon oral suspension) requires prior authorization through UnitedHealthcare/OptumRx for pediatric Smith-Magenis syndrome patients ages 3-15 in Georgia. Start by confirming your diagnosis with genetic testing (17p11.2 deletion or RAI1 mutation), then submit the PA request via

How to Get Givlaari (givosiran) Covered by UnitedHealthcare in Pennsylvania: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Givlaari Covered by UnitedHealthcare in Pennsylvania Eligibility: UnitedHealthcare requires prior authorization for Givlaari (givosiran) with specific criteria: confirmed acute hepatic porphyria diagnosis, elevated ALA/PBG levels, at least 2 documented attacks in 6 months, and specialist involvement. Fastest Path: Have your hematologist, hepatologist, or gastroenterologist submit a

Do You Qualify for Firdapse Coverage by UnitedHealthcare in Virginia? Decision Tree & Next Steps

Answer Box: Your Path to Firdapse Coverage in Virginia You likely qualify for Firdapse (amifampridine) coverage by UnitedHealthcare if: you're 6+ years old with confirmed LEMS diagnosis (EMG + antibody testing), prescribed by a neurologist, and not using other potassium channel blockers. UnitedHealthcare requires prior authorization but no step

How to Get Hetlioz LQ (tasimelteon oral suspension) Covered by UnitedHealthcare in Michigan: Appeals Guide & Templates

Answer Box: Getting Hetlioz LQ Covered by UnitedHealthcare in Michigan Fast Track to Approval: UnitedHealthcare requires prior authorization for Hetlioz LQ (tasimelteon oral suspension) for pediatric Smith-Magenis syndrome patients ages 3-15. You need genetic testing confirming SMS diagnosis, specialist involvement, and documented sleep disturbances. If denied, you have internal appeals

How to Get Uptravi (Selexipag) Covered by UnitedHealthcare in Texas: Complete Guide to Prior Authorization, Appeals, and Approval

Answer Box: Getting Started To get Uptravi (selexipag) covered by UnitedHealthcare in Texas: Your doctor submits a prior authorization through the UnitedHealthcare Provider Portal or by calling 888-397-8129. You'll need documented WHO Group I PAH diagnosis, functional class II-IV status, and evidence of step therapy compliance or contraindications