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Covered
Anthem covers various treatments and situations related to allergy immunotherapy, provided the procedures are deemed medically necessary. For many patients, Anthem provides coverage for allergy testing to identify specific allergens. Upon confirmation of allergies, Anthem may cover both subcutaneous immunotherapy (SCIT), commonly known as allergy shots, and sublingual immunotherapy (SLIT), which involves dissolvable tablets placed under the tongue. Pre-authorization may be required to ensure coverage. Furthermore, certain prescription medications associated with allergy treatment and management might also be covered under Anthem's pharmacy benefits, subject to an individual's specific health plan details. It is essential for patients to review their policy or consult with Anthem directly to understand the extent of their coverage, including any required co-payments or deductibles that apply to their allergy immunotherapy treatments.
Uncovered
Anthem may not cover treatments deemed experimental or investigational, including certain off-label drug uses not approved by the FDA for a specific condition. Services related to work injuries, governmental action, or those covered under other insurance may be excluded. Treatments for cosmetic purposes, such as procedures not medically necessary, are generally not covered. Educational services, like cognitive training, and non-medical ancillary services, including convenience or comfort items, are typically excluded from coverage. Additionally, self-administered drugs could be excluded depending on the specific plan details.
