Immunotherapy and Insurance: Coverage Options with EmblemHealth

Explore allergy immunotherapy coverage options with EmblemHealth. Understand insurance benefits and maximize your treatment affordability today.
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Does EmblemHealth Cover Allergy Immunotherapy?

EmblemHealth generally covers allergy immunotherapy when deemed medically necessary, including allergy shots and sublingual tablets, following their specific plan guidelines. Coverage details vary by individual policy.

For EmblemHealth coverage of allergy immunotherapy:

1. Obtain a referral from your primary care physician to a certified allergist.
2. Undergo allergy testing to confirm the allergens that cause reactions.
3. The allergist must provide documentation showing the medical necessity of immunotherapy.
4. Ensure the prescribed treatment aligns with EmblemHealth’s clinical guidelines for immunotherapy.
5. Pre-authorization may be required; check your specific plan details.
6. Treatment must be administered under medical supervision with emergency measures available for adverse reactions.
7. Length of coverage varies; maintenance treatment may have time or visit limits.
8. Check if your plan specifies in-network providers to avoid out-of-pocket increases.

Restrictions:
- Over-the-counter treatments and non-standard allergy testing (e.g., cytotoxicity testing) may not be covered.
- Some plans may not cover oral immunotherapy.
- Certain medication or visit limits may apply; review your policy for specifics.

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Covered

EmblemHealth provides coverage for a variety of treatments and situations for those dealing with allergies. This includes diagnostic testing such as skin tests and blood tests to determine specific allergens. Once allergies are diagnosed, EmblemHealth may cover allergy shots (subcutaneous immunotherapy) that are tailored to desensitize the immune system to specific allergens. Moreover, the plan typically covers pharmacotherapy, involving medications such as antihistamines, nasal corticosteroids, or inhalers for asthma, which is commonly associated with allergies. In the case of anaphylaxis, a life-threatening allergic reaction, EmblemHealth insurance may cover the cost of emergency treatments, including epinephrine auto-injectors. Preauthorization might be required for some treatments to ensure coverage. Always check with EmblemHealth for the specifics of your plan.

Uncovered

EmblemHealth may not cover treatments such as cosmetic surgery, except when medically necessary, and experimental or investigational procedures that lack significant medical documentation supporting their efficacy. Coverage for services provided by non-network providers without prior approval may also be excluded. Additionally, over-the-counter medications and certain types of alternative therapies that are not deemed medically necessary might not be covered. Personal comfort items, custodial care, and educational services for conditions like ADD/ADHD can also fall outside of coverage. It's crucial for policyholders to consult their specific plan documents for a detailed list of exclusions.

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Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

Step-by-Step Guide to Starting Allergy Immunotherapy with EmblemHealth

1. Review your EmblemHealth plan details for allergy immunotherapy coverage.
2. Obtain a referral or prescription for immunotherapy from your primary care physician or allergist.
3. Contact EmblemHealth Customer Service at 1-877-411-3625 to verify benefits and understand any prerequisites for coverage.
4. Ask about pre-authorization requirements for the specific immunotherapy treatment prescribed.
5. Inquire about in-network providers for allergy immunotherapy to maximize coverage and minimize out-of-pocket costs.
6. Request information on claim submission processes or if direct billing by the provider is accepted.
7. Confirm any copayments, coinsurance, or deductibles that will apply to your treatment.
8. Schedule your allergy immunotherapy sessions with an approved provider.

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Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
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Treatment prescribed
by clinician

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Clinicaly made allergen extracts are customized for your allergies

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Your immune system gets desensitized to allergens, giving you long-term relief.

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