Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 619 issues

How to Get Onpattro (Patisiran) Covered by UnitedHealthcare in California: Complete Coding, Appeals, and IMR Guide

Answer Box: Getting Onpattro (Patisiran) Covered by UnitedHealthcare in California Onpattro (patisiran) requires prior authorization from UnitedHealthcare OptumRx for hereditary transthyretin amyloidosis polyneuropathy (hATTR-PN). Key requirements: genetic confirmation of pathogenic TTR mutation, neurologist evaluation, and proper ICD-10 coding (E85.1). If denied, file internal appeal within 60 days, then escalate
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Getting Cimzia (Certolizumab Pegol) Covered by UnitedHealthcare in Illinois: Prior Authorization, Appeals & Forms

Quick Answer: Getting Cimzia Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Cimzia (certolizumab pegol) in Illinois. You'll need documentation of diagnosis (Crohn's, RA, etc.), tuberculosis/hepatitis B screening, and evidence of failed first-line treatments. Submit through the UnitedHealthcare provider portal with complete clinical
5 min read

UnitedHealthcare Coverage for iLink® Corneal Cross-Linking in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting iLink® Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for iLink® corneal cross-linking in New Jersey. Coverage is available for progressive keratoconus when you meet strict medical necessity criteria using FDA-approved protocols. Your fastest path to approval: Have your ophthalmologist submit a prior authorization through
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How to Get Spinraza (nusinersen) Covered by UnitedHealthcare in Ohio: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Spinraza Covered by UnitedHealthcare in Ohio Fast Track to Approval: UnitedHealthcare requires prior authorization for Spinraza (nusinersen) with genetic confirmation of 5q SMA, baseline motor function scores, and specialist attestation. If denied, Ohio law provides strong step therapy override protections and a 180-day window for external review
6 min read

How to Get Spinraza (nusinersen) Covered by UnitedHealthcare in North Carolina: Renewal Guide, Appeals, and Timeline

Answer Box: Renewing Spinraza Coverage with UnitedHealthcare in North Carolina UnitedHealthcare requires annual prior authorization renewal for Spinraza (nusinersen), limited to 3 maintenance doses per 12 months. Submit renewal requests 30-60 days before your current authorization expires. Required documentation includes updated motor function assessments (HFMSE or RULM scores showing ≥3-point
6 min read

How to Get Strimvelis Gene Therapy Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Strimvelis Covered by UnitedHealthcare in Washington Strimvelis gene therapy for ADA-SCID requires prior authorization from UnitedHealthcare through OptumRx, with extensive documentation of genetic diagnosis (ICD-10 D81.31), failed standard therapies, and specialist support. Since Strimvelis isn't FDA-approved and is only available in Milan, Italy, you&
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Renewing Opsumit (Macitentan) Approval with UnitedHealthcare in North Carolina: 2025 Requirements & Timeline

Answer Box: Opsumit (macitentan) renewal with UnitedHealthcare in North Carolina requires submitting updated clinical documentation 30-60 days before your current authorization expires. Key 2025 changes: OptumRx is eliminating many chronic disease reauthorizations, but Opsumit's status must be verified through your provider portal. If still required, submit WHO functional
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How to Get Jakafi (Ruxolitinib) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: UnitedHealthcare requires prior authorization for Jakafi (ruxolitinib) with strict medical necessity criteria. You'll need FDA-approved diagnosis documentation, proof of failed prior therapies (like hydroxyurea for polycythemia vera), and current lab results. Submit through UHC's provider portal with comprehensive clinical documentation. If denied, you have
6 min read

How to Get Firdapse (Amifampridine) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Firdapse Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Firdapse (amifampridine) in Michigan, with no step therapy required for confirmed LEMS patients. The fastest path to approval: (1) Ensure your neurologist has documented LEMS diagnosis with P/Q-type VGCC antibodies and EMG findings, (2) Submit
6 min read