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Covered
Blue Cross Blue Shield typically covers a range of treatments and situations associated with allergy immunotherapy, considering it as a medically necessary preventive service. Coverage usually includes diagnostic testing to confirm allergies, such as skin tests and specific IgE blood tests. Once allergies are confirmed, the plan often covers both subcutaneous immunotherapy (SCIT), commonly known as allergy shots, and sublingual immunotherapy (SLIT), in the form of under-the-tongue tablets for certain types of allergens like grass pollens, dust mites, and ragweed. The costs for the preparation of allergenic extracts and the administration of the immunotherapy are usually included as part of the policy benefits. The coverage for these treatments is subject to policy terms, including copays, deductibles, and coinsurance, and may require prior authorization to ensure the treatment plan meets established medical criteria.
Uncovered
Blue Cross Blue Shield typically does not cover treatments that are deemed experimental or investigational, including certain new drug therapies not yet approved by the FDA. Additionally, coverage may be excluded for cosmetic procedures not medically necessary, such as hair transplants or cosmetic surgery. Fertility treatments, like in vitro fertilization (IVF), can often be excluded as well. Services related to self-inflicted injuries or conditions due to non-compliant behaviors may also be non-covered situations. Certain over-the-counter medications and supplements are typically not covered unless prescribed by a healthcare provider. It is essential for members to review their specific plan details, as exclusions can vary.
