Immunotherapy and Insurance: Coverage Options with Gateway Health Plan

Discover allergy immunotherapy coverage options with Gateway Health Plan. Learn about insurance benefits and ensure your treatment is fully covered.
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Does Gateway Health Plan Cover Allergy Immunotherapy?

Gateway Health Plan typically covers allergy immunotherapy when deemed medically necessary. Coverage may vary based on the specific plan and patient needs; check your plan details for exact provisions.

For Gateway Health Plan coverage of allergy immunotherapy:

1. Get a referral or prescription from an in-network physician.
2. Prior authorization might be required; submit your provider's assessment.
3. Determine if coverage includes both subcutaneous (SCIT) and sublingual (SLIT) therapies.
4. Review the plan's formulary; certain allergen extracts may not be covered.
5. Treatment must be deemed medically necessary.
6. Understand any plan-specific visitation limits or duration restrictions for therapy.
7. Keep detailed records of treatment dates and progress.
8. Be cognizant of potential copays or deductible amounts for procedures.
9. For ongoing treatment coverage, periodic reassessment documentation may be required.

Check your specific policy for further details on restrictions or additional steps.

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Covered

Gateway Health Plan typically provides coverage for a variety of treatments and situations to support the health of its members. They may cover doctor visits, preventative care services, including vaccinations and health screenings, hospital stays, and emergency care. Coverage often extends to prescription drugs, mental health services, and substance abuse treatment. Depending on the plan specifics, they might also include physical therapy, occupational therapy, and speech therapy. Maternity and newborn care, along with pediatric services, are often covered benefits. Additionally, treatments for chronic diseases and certain medical equipment may be covered under Gateway Health Plan policies. Always check with Gateway Health Plan for the most accurate and personalized coverage information pertaining to your specific policy and health needs.

Uncovered

Gateway Health Plan, like other insurance providers, typically does not cover certain types of treatments and situations. These exclusions can include experimental or investigational treatments, procedures deemed not medically necessary, certain cosmetic surgeries, and weight loss programs or surgeries not considered essential for health. Coverage might also exclude procedures related to gender transformation if deemed not medically necessary. Furthermore, the plan may not cover over-the-counter medications, specific dental and hearing care, and elective abortions. For exact details, members should consult their specific plan documentation.

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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.

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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.

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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 Gateway Health Plan

To begin allergy immunotherapy with Gateway Health Plan, follow these steps:

1. Obtain Referral: If required, get a referral from your primary care provider (PCP) to see an allergist.
2. Consult an Allergist: Schedule an appointment with an in-network allergist for an evaluation.
3. Coverage Confirmation: During the consultation, ask the allergist to verify coverage for immunotherapy under your plan.
4. Pre-Authorization: Request that the allergist’s office obtain pre-authorization from Gateway Health, if necessary.
5. Documentation: Ensure all medical necessity documents are prepared by the allergist to support the therapy.
6. Contact Gateway Health: Reach out to Gateway Health customer service at the number on your member ID card for specific plan details and approval process.

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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
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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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