Trying to find out if sublingual immunotherapy (allergy drops) are covered under my plan.
Good afternoon, I would be happy to review your benefit plan coverage for allergy treatments.
Below is a link to our coverage policy regarding allergy treatments as a whole. It is encouraged to review this with your referring/rendering provider to ensure you would meet the requirements for coverage.
Medical and Pharmacy Coverage Policies - Search Results
If the specific treatment does fall within coverage guidelines, your benefit plan allows for general services to be payable at a 100% for allergy testing, and 100% following a $5.00 copayment for injections.
Major services are payable at an 80% coinsurance level following a $1000 deductible. There is a $4000 plan maximum out of pocket.
This applies to services performed in network.
For assistance locating an in network provider, you can follow the instructions here:
What providers are in my network?
Please note - some services do require prior authorization which is obtained by having your referring provider contact our Clinical Intake team at 800 - 523 - 0023.
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