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Covered
UnitedHealthcare may cover allergy immunotherapy for members who have a documented medical necessity for the treatment, as evidenced by an allergy test confirming specific allergen sensitivity. A doctor's referral is typically required. Preauthorization is generally a prerequisite for coverage, which encompasses subcutaneous allergy injections and FDA-approved sublingual immunotherapy tablets. Healthcare provider documentation must detail the significance of the allergic reactions, the inadequacy of standard treatment options, and a clear immunotherapy treatment plan. Coverage stipulations will include the therapy's frequency and total duration limits, tailored to the individual's needs and specific plan details.
Uncovered
UnitedHealthcare may not cover allergy treatments that are considered over-the-counter, including non-prescription antihistamines and nasal sprays. Experimental or investigational procedures, such as certain alternative medicine therapies, are typically excluded from coverage. Other exclusions may encompass services deemed not medically necessary, or those lacking a doctor's referral and confirmed allergy testing. Immunotherapy exceeding set frequency or duration limits may also be ineligible for coverage. Any allergy care unrelated to confirmed allergen sensitivities may be denied, as well as off-label medication use not approved for allergy treatment.
