Immunotherapy and Insurance: Coverage Options with Tufts Health Plan

Discover how Tufts Health Plan covers allergy immunotherapy. Learn about insurance options, eligibility, and benefits for effective allergy treatment.
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Does Tufts Health Plan Cover Allergy Immunotherapy?

Tufts Health Plan generally covers allergy immunotherapy if it is deemed medically necessary. Coverage details may vary based on individual policy terms.

Tufts Health Plan covers allergy immunotherapy when medically necessary and appropriately documented. Members need a referral from their primary care physician (PCP) and preauthorization from Tufts. Documentation should demonstrate a history of allergic reactions and the failure of standard treatments. Skin or blood testing is required to confirm specific allergens.

Coverage includes:
- Preparation of allergenic extracts.
- Injection schedules following standard protocols.
- Office visits for injections; typically, build-up phase and maintenance.

Restrictions include:
- Non-standard allergy testing methods are not covered.
- Over-the-counter treatments and non-specific immunotherapy are excluded.
- Services must be provided by a network allergist.

Always verify with Tufts for potential changes or updates to coverage.

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Covered

Tufts Health Plan offers coverage for various allergy immunotherapy treatments, provided they are deemed medically necessary. This includes allergy shots (subcutaneous immunotherapy), which are injections administered over a period of time to reduce sensitivity to allergens. Moreover, the plan may cover prescription medications that are part of an allergy treatment plan, such as antihistamines, nasal corticosteroids, and leukotriene modifiers. Additionally, some plans may include the newer sublingual immunotherapy (SLIT), which involves placing a tablet containing the allergen under the tongue. Coverage specifics, including duration and scope of treatment, can vary depending on the individual plan, so policyholders should consult their plan documents or contact Tufts Health Plan directly for precise information on allergy treatment coverage.

Uncovered

Tufts Health Plan typically may not cover services and treatments deemed as non-medically necessary, cosmetic procedures, experimental or investigational therapies, and weight control services. Furthermore, uncovered situations could include self-inflicted injuries, elective abortions, and custodial care. Coverage exclusions often extend to over-counter medications, personal comfort items, and alternative treatments like acupuncture, unless deemed essential and included in the plan. It's essential to review the specific plan details for a comprehensive list of exclusions.

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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.

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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 Tufts Health Plan

1. Contact Tufts Health Plan: Call Member Services using the number on your insurance card.
2. Verify Coverage: Ask about "allergy immunotherapy coverage specifics" under your plan.
3. Reference Code: Mention CPT codes 95165 for serum and 95115/95117 for injections to aid in benefit determination.
4. Documentation: Inquire what documentation is necessary from your allergist to facilitate coverage.
5. Pre-authorization: Ask if a pre-authorization is required for the treatment.
6. Network Providers: Confirm you're seeing an in-network allergist for maximum benefits.
7. Out-of-pocket Costs: Request information on copays, deductibles, and co-insurance for treatments.
8. Follow Up: Obtain a reference number for your call and document who you spoke with for future reference.

Begin with these steps to ensure you have a clear understanding of your benefits and know how to proceed with your allergy immunotherapy process with Tufts Health Plan.

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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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