Immunotherapy and Insurance: Coverage Options with Presbyterian Healthcare Services

Explore allergy immunotherapy coverage options with Presbyterian Healthcare Services. Discover how your insurance provider supports your treatment needs.
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“Curex is changing the landscape of allergies in 2024”
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Does Presbyterian Healthcare Services Cover Allergy Immunotherapy?

Presbyterian Healthcare Services typically covers allergy immunotherapy, including allergy shots and sublingual tablets, subject to plan specifics and medical necessity. Always refer to your policy for detailed coverage information.

To have allergy immunotherapy covered by Presbyterian Healthcare Services, the treatment must be deemed medically necessary and prescribed by a healthcare provider. Prior authorization may be required. Patients should ensure their provider submits comprehensive documentation, including a detailed history of allergies, proof of failed conventional treatments, and results from allergy tests. Coverage might be limited to specific types of immunotherapy, such as subcutaneous injections over sublingual methods. Dosage, frequency, and duration of therapy could be subject to plan restrictions. Exclusions may apply for experimental procedures or for services not deemed standard care. Always check your specific plan for additional limitations or patient responsibility.

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Covered

Presbyterian Healthcare Services provides coverage for a range of treatments and situations to support the health of its members. This includes preventive care such as vaccinations and screenings, emergency medical services, and hospitalization. Members can access primary care consultations, specialist visits, prescription drugs, and maternity care. The plan also covers mental health services, including therapy and counseling, along with rehabilitation services like physical therapy. For those with chronic conditions, disease management programs may be available. It's also worth noting that various surgical procedures, diagnostic imaging, and lab tests are typically covered under Presbyterian plans. Coverage specifics can vary, so members should consult their plan details for precise information on what is included.

Uncovered

In the landscape of health insurance, Presbyterian Healthcare Services often delineates specific areas that fall outside of its coverage scope. Notably, this includes over-the-counter medications and treatments. These items, readily available without a doctor's prescription, are typically not covered under their plans. Furthermore, treatments classified as experimental or investigational do not receive coverage due to their unproven status in mainstream medical practice. Also excluded are procedures and treatments that are not recognized as medically necessary. These criteria, set by healthcare professionals, help to define what is essential for health and what falls outside of this realm. Such exclusions are standard in the industry and are an important aspect for policyholders to understand when navigating their healthcare coverage.

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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 Presbyterian Healthcare Services

1. Visit Presbyterian Healthcare Services website.
2. Locate the 'Contact Us' page for member services contact information.
3. Call the member services hotline, ensuring you have your ID card at hand.
4. Inquire about coverage details for allergy immunotherapy under your specific plan.
5. Ask about the pre-authorization process and necessary medical criteria.
6. Request a list of in-network providers who specialize in allergy immunotherapy.
7. Follow instructions for submitting any required referrals or pre-treatment assessments.
8. Schedule an appointment with the in-network allergy specialist.
9. Ensure to keep all documentation for future reference and claims.

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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 Presbyterian Healthcare Services

Explore allergy immunotherapy coverage options with Presbyterian Healthcare Services. Discover how your insurance provider supports your treatment needs.
Curex allergy drops unboxing

Allergy Immunotherapy Options with Presbyterian Healthcare Services

To have allergy immunotherapy covered by Presbyterian Healthcare Services, the treatment must be deemed medically necessary and prescribed by a healthcare provider. Prior authorization may be required. Patients should ensure their provider submits comprehensive documentation, including a detailed history of allergies, proof of failed conventional treatments, and results from allergy tests. Coverage might be limited to specific types of immunotherapy, such as subcutaneous injections over sublingual methods. Dosage, frequency, and duration of therapy could be subject to plan restrictions. Exclusions may apply for experimental procedures or for services not deemed standard care. Always check your specific plan for additional limitations or patient responsibility.

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Uncovered and Covered Immunotherapy with Presbyterian Healthcare Services

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 Presbyterian Healthcare Services

1. Visit Presbyterian Healthcare Services website.
2. Locate the 'Contact Us' page for member services contact information.
3. Call the member services hotline, ensuring you have your ID card at hand.
4. Inquire about coverage details for allergy immunotherapy under your specific plan.
5. Ask about the pre-authorization process and necessary medical criteria.
6. Request a list of in-network providers who specialize in allergy immunotherapy.
7. Follow instructions for submitting any required referrals or pre-treatment assessments.
8. Schedule an appointment with the in-network allergy specialist.
9. Ensure to keep all documentation for future reference and claims.

Premium Medication you can trust

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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Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

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Everything you need is included:

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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?

Semaglutide:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1 mg, 1.7 mg and 2.4 mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5 mg and 5 mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10 mg and 12.5 mg of tirzepatide for an additional $50 per month for each plan.

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.