Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1141 issues

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in Georgia: Prior Authorization Guide and Appeal Process

Answer Box: Getting Tepezza Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Tepezza (teprotumumab) with specific criteria: moderate-to-severe thyroid eye disease diagnosed by an ophthalmologist/endocrinologist, euthyroid status, documented corticosteroid trial or contraindication, and Clinical Activity Score ≥3. Fastest path: Have your specialist submit a complete PA request
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Getting Mycapssa (Octreotide, Oral) Approved by UnitedHealthcare in New Jersey: A Complete Coverage Guide

Answer Box: Getting Mycapssa Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Mycapssa (oral octreotide) with specific step therapy requirements: confirmed acromegaly diagnosis, prior response to injectable octreotide or lanreotide, and clinical justification for switching to oral therapy. Submit PA requests through OptumRx portals with complete documentation.
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Renewing Synagis (Palivizumab) Approval with UnitedHealthcare in Florida: Complete Guide to Seasonal Authorization and Appeals

Answer Box: Renewing Synagis (Palivizumab) with UnitedHealthcare in Florida Synagis renewal requires a new prior authorization request for each RSV season (typically October-March). UnitedHealthcare doesn't approve ongoing renewals within the same season except post-surgery cases. Start your renewal process 60 days before the new RSV season begins. First
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How to Get Rezlidhia (olutasidenib) Covered by UnitedHealthcare in Illinois: Appeals, Forms, and Approval Timeline

Answer Box: Getting Rezlidhia Covered in Illinois UnitedHealthcare requires prior authorization for Rezlidhia (olutasidenib) with documented IDH1 mutation and relapsed/refractory AML. Fastest path: Submit PA with IDH1 test results, prior therapy documentation, and oncologist's medical necessity letter via UnitedHealthcare provider portal. If denied, file internal appeal within
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How to Get Firdapse (Amifampridine) Covered by UnitedHealthcare in Pennsylvania: Complete Guide with Appeals Process

Answer Box: Getting Firdapse Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Firdapse (amifampridine) for Lambert-Eaton myasthenic syndrome (LEMS). No step therapy is required, but you need confirmed LEMS diagnosis with antibody testing and EMG documentation from a neuromuscular specialist. Submit PA through the UnitedHealthcare Provider Portal. If
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How to Get Evrysdi (Risdiplam) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Evrysdi Approved by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Evrysdi (risdiplam) with strict criteria: confirmed SMN1 gene mutation, no invasive ventilation dependency, and no concurrent Spinraza use. Submit through the UnitedHealthcare Provider Portal with genetic testing, motor function assessments (CHOP INTEND/HFMSE), and specialist documentation.
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How to Get Gilenya (fingolimod) Covered by UnitedHealthcare in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Gilenya Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Gilenya (fingolimod) in Texas. Submit through the UnitedHealthcare Provider Portal with complete documentation: baseline EKG, ophthalmology exam, vaccination records, and step therapy documentation. If denied, you have 60 days for internal appeal, then 4 months for
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How to Get Synagis (Palivizumab) Covered by UnitedHealthcare in Virginia: Complete Authorization Guide

Answer Box: Getting Synagis Covered by UnitedHealthcare in Virginia Synagis (palivizumab) requires prior authorization from UnitedHealthcare for high-risk infants meeting specific RSV prevention criteria. The fastest path to approval: (1) Submit the UnitedHealthcare Synagis Authorization Request Form with complete clinical documentation including gestational age ≤35 weeks or qualifying heart/lung
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How to Get Eloctate Covered by UnitedHealthcare in Virginia: Renewal Guide, Appeals Process, and Emergency Bridge Options

Answer Box: UnitedHealthcare requires annual prior authorization renewal for Eloctate in Virginia. Start the renewal process 60-90 days before your current authorization expires to avoid treatment gaps. Submit renewal requests via the OptumRx provider portal or fax with updated clinical documentation including bleeding logs, factor levels, and provider attestation. If
6 min read