Immunotherapy and Insurance: Coverage Options with Molina Healthcare

Discover your allergy immunotherapy coverage options with Molina Healthcare. Learn about your insurance benefits and get guidance on navigating your healthcare plan.
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Does Molina Healthcare Cover Allergy Immunotherapy?

Molina Healthcare typically covers allergy immunotherapy when medically necessary. Coverage details may vary, so review your plan or consult your policy documentation for specifics.

For Molina Healthcare, coverage for allergy immunotherapy typically requires a confirmed diagnosis of allergic rhinitis or asthma from an in-network provider. Precise documentation highlighting the medical necessity, such as a detailed history, allergy testing results, and previous treatment attempts, is crucial.

The prescribing allergist must submit a treatment plan outlining the dosage and duration of the therapy. Any limitations will be based on Molina's policy provisions, which may include the number of treatments per year or lifetime caps on sessions.

Prior authorization may be necessary, and ongoing treatment often requires periodic reviews. Coverage for maintenance therapy may have specific qualifiers, and out-of-network services might incur higher out-of-pocket costs or not be covered at all. Ensure adherence to Molina's policy updates, as immunotherapy coverage can evolve.

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Covered

Molina Healthcare provides coverage for a range of treatments and situations regarding allergy immunotherapy, which is designed to help patients manage and decrease their sensitivity to allergens. Coverage typically includes diagnostic testing to identify specific allergens, standard immunotherapy injections (often referred to as allergy shots), and sublingual immunotherapy (SLIT), which is a form of treatment that involves placing a tablet containing the allergen under the tongue. The policy generally supports both the initial phase, where doses are administered more frequently to build up immunity, and the maintenance phase that involves longer intervals between doses to sustain immunity. Precise coverage details and associated costs can vary depending on the individual's specific plan and the state regulations, so it is recommended to review the policy or speak directly with a Molina Healthcare representative for personalized information.

Uncovered

Molina Healthcare may not cover treatments and situations such as cosmetic surgery that is not medically necessary, experimental or investigational procedures, out-of-network services without prior authorization (except in emergencies), and certain over-the-counter medications. Additionally, care that is considered not medically necessary, such as some elective procedures or those for convenience, may also be excluded. Coverage also typically does not extend to services related to work injuries or conditions covered under workers' compensation. It's important to note that exclusions can vary by policy and state, and members should consult their specific plan documents for detailed coverage information.

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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.

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 Molina Healthcare

1. Contact Molina Healthcare: Begin by calling Molina Healthcare's customer service at the number found on your insurance card.
2. Member Services Inquiry: Request information on allergy immunotherapy coverage.
3. Policy Details: Ask about your specific policy benefits, coverage limitations, copays, and deductibles.
4. Preferred Providers: Inquire about in-network providers to ensure maximum coverage for the immunotherapy.
5. Referral & Pre-authorization: Ask if you need a referral from a primary care physician or pre-authorization for the treatment.
6. Documentation: Find out which documentation is necessary (e.g., allergy test results) to support the need for immunotherapy.
7. Claims Process: Understand the claims submission process if you'll need to file claims for reimbursement.
8. Follow-Up: Request an email or written confirmation of the conversation with details about the 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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