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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“Curex is changing the landscape of allergies in 2024”
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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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Review your allergy test results with a Curex allergist.

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 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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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.
Curex allergy drops unboxing

Allergy Immunotherapy Options with Molina Healthcare

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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Uncovered and Covered Immunotherapy with Molina Healthcare

Together with our partners we have changed the lives of over 300,000 patients.

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 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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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

The initial sign-up fee of $19.99 covers the review of your medical information as well as the prescription. For the medication itself, we have different plans at unbeatable prices. Semaglutide starts at $149 per month and tirzepatide starts at $299 per month. Your Curex care manager will help you find the right plan. Insurance is not needed. You can use your FSA/HSA account. There are no membership fees and no upcharges for higher dosages.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Alaska, Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.