Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1139 issues

Myths vs. Facts: Getting Adynovate (Antihemophilic Factor VIII) Covered by UnitedHealthcare in Ohio

Quick Answer: Getting Adynovate Covered by UnitedHealthcare in Ohio Fact: UnitedHealthcare requires prior authorization and often step therapy for Adynovate (antihemophilic factor VIII). You'll need documentation of severe hemophilia A diagnosis, prior treatment history, and medical necessity justification. If denied, you have 65 days to appeal internally, then

How to Get Rapivab (Peramivir) Covered by UnitedHealthcare in New Jersey: Prior Authorization Guide 2025

Quick Answer: Getting Rapivab Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Rapivab (peramivir) through OptumRx and is not on the 2024 commercial formulary, making it non-formulary with higher costs or potential denial. To get coverage: (1) Your doctor submits a prior authorization via the UnitedHealthcare Provider

Do You Qualify for Revlimid Coverage by UnitedHealthcare in Pennsylvania? Decision Tree & Next Steps

Answer Box: Getting Revlimid Covered by UnitedHealthcare in Pennsylvania You likely qualify for Revlimid (lenalidomide) coverage if you have multiple myeloma, MDS with 5q deletion, or an NCCN-supported indication. UnitedHealthcare requires prior authorization through OptumRx, REMS program enrollment, and comprehensive clinical documentation. First step today: Verify your diagnosis meets coverage

Get iLink® Corneal Cross-Linking Covered by UnitedHealthcare in Pennsylvania: Prior Authorization Guide & Appeal Process

Quick Answer: Getting iLink® Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare covers iLink® corneal cross-linking for progressive keratoconus when using FDA-approved Photrexa solutions and the KXL system. Prior authorization is required with documented disease progression. If denied, Pennsylvania's new external review program has overturned about 50% of appealed denials

Lowering Out-of-Pocket Costs for Vimizim (Elosulfase Alfa) with UnitedHealthcare in Florida: Copay Programs, Appeals & Financial Aid

Answer Box: Getting Vimizim Coverage in Florida Vimizim (elosulfase alfa) requires prior authorization from UnitedHealthcare and typically costs $700K-$2.1M annually. To minimize out-of-pocket expenses in Florida: 1) Apply for BioMarin's copay assistance program if you have commercial insurance (call 1-866-906-6100), 2) Request prior authorization through your

Renewing Oxervate (Cenegermin) Approval with UnitedHealthcare in Texas: Timeline, Documents & What to Prepare

Answer Box: Renewing Oxervate Coverage with UnitedHealthcare in Texas Oxervate (cenegermin) renewal with UnitedHealthcare requires reauthorization for each 8-week course. Start the renewal process 2-3 weeks before your current approval expires. You'll need updated ophthalmology records showing stage 2-3 neurotrophic keratitis, corneal sensitivity testing, and documentation of treatment

Do You Qualify for Thiola / Thiola EC Coverage by UnitedHealthcare in New York? Decision Tree & Next Steps

Answer Box: Your Path to Thiola Coverage To get Thiola/Thiola EC covered by UnitedHealthcare in New York, you need: confirmed cystinuria diagnosis (ICD-10: E72.01), documented failure of conservative therapy (alkalinization with potassium citrate for ≥3 months), 24-hour urine cystine levels >250-300 mg/day, and specialist involvement (urologist/

How to Get Qalsody (Tofersen) Covered by UnitedHealthcare in New York: Complete Coding, Appeals & Forms Guide

Answer Box: Getting Qalsody Covered by UnitedHealthcare in New York Qalsody (tofersen) requires prior authorization from UnitedHealthcare and is covered under the medical benefit using J-code J1304. Key requirements: confirmed SOD1 gene mutation, ALS diagnosis (ICD-10: G12.21), baseline neurofilament light chain (NfL) levels, and ALSFRS-R score ≥24. If denied,

How Long Does It Take to Get Vyondys 53 (Golodirsen) Approved by UnitedHealthcare in Florida? Complete Timeline Guide

Answer Box: Vyondys 53 Approval Timeline in Florida Getting Vyondys 53 (golodirsen) approved by UnitedHealthcare in Florida typically takes 7-14 days for standard prior authorization, or 72 hours for expedited requests. The process requires genetic testing confirming exon 53-skippable DMD mutation, step therapy documentation, and infusion monitoring plans. Start by

Getting Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in Florida: Coding, Appeals, and Success Strategies

Answer Box: Quick Path to Coverage To get Exondys 51 (eteplirsen) covered by UnitedHealthcare in Florida: Submit prior authorization with genetic testing confirming exon 51-amenable DMD mutation (ICD-10: G71.01), neurologist evaluation, and stable corticosteroid documentation. Use HCPCS J-code J1428 for billing (1 unit = 10mg). If denied, file internal appeal