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Are Allergy Tests Covered By Insurance

by Lyndon Langley
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Are Allergy Tests Covered By Insurance

Are Allergy Tests Covered By Insurance

You’re sitting in a waiting room with other people who have been poked and prodded by medical professionals. You might even be wearing disposable gloves and a surgical mask to keep from getting exposed to any of the illnesses that can spread during an office visit. The doctor tells you what’s going on, explains why he wants to test you for allergies (most often food allergies) and then says something like “We’ll schedule all these tests at once because they’re related.” What exactly does this mean? It means that instead of having several separate appointments over the next few days or weeks to get tested for various allergies, you will only need one appointment to do everything—and it will cost less money!

Allergies occur when your immune system mistakes certain substances for foreign invaders and launches a response. This response causes inflammation throughout your body. One way your immune system fights off allergens is through immunoglobulin E antibodies (IgE). When you come into contact with an allergen, your IgE binds to it and triggers allergic reactions such as runny nose, watery eyes, hives and asthma attacks. In order to determine which specific allergens cause these symptoms, your doctor needs to take some blood samples and perform skin prick tests and/or blood tests called radioallergosorbent tests (RASTs). These tests require specialized equipment and personnel, both of which may not be available in every practice.

The good news is that many insurance companies cover allergy testing and treatments. According to the National Institutes of Health (NIH), most health insurance programs pay 100 percent of the charges for diagnostic procedures, including allergy testing and immunotherapy. Some private insurers offer coverage up to 90 percent of the fees, but the percentage varies depending upon each insurer’s policy. Your best bet is to call your insurance company and ask about their policies; however, there is no guarantee that they won’t reduce the amount paid out based on a claim.

What Are Allergy Shots?

If you decide to go ahead with allergy testing, there are two main options. There are medications to prevent you from being exposed to an allergen that you might encounter outside the home, and there are injections that provide long-lasting relief from allergies.

Medications used to treat allergies include oral tablets, eye drops and nasal sprays. Medication usually requires more frequent dosing than injection therapy, which we discuss below. However, oral medication is considered safer than injectable forms because it doesn’t involve needles. Additionally, oral antihistamines don’t interact well with other drugs. For example, if you are taking prescription medicine for depression, you should avoid using antihistamines because they tend to make depressed patients feel sleepy. On the other hand, injectables work well with other types of drugs. They also allow your doctor to change dosage amounts as needed, rather than just relying on a daily pill. Because of these benefits, medications are generally preferred among adults.

Injections are performed by doctors trained in administering allergy shots. During the procedure, a nurse or physician will place a small needle under the patient’s skin near his or her neck where the subcutaneous tissue layer meets the muscle layer. Once the needle pierces the skin, a tiny opening is created, and a tiny syringe containing the allergen extract is placed inside. The nurse presses down on the plunger to withdraw liquid from the syringe and squirts the substance directly into the tissue. Afterward, she closes the wound site with adhesive tape.

Your doctor will likely recommend allergy shots as part of the treatment plan. Unlike oral medication, allergy shots are effective immediately after they are administered. With either method, you will typically experience side effects for a couple of weeks after the initial shot. Common side effects associated with allergy shots include redness, swelling, itchiness and tenderness around the injection site.

How Much Does Testing Cost?

While it is true that allergy testing and treatments are covered by most insurance plans, how much your co-pay will be depends on your individual situation. Most insurance carriers use a flat fee per person per calendar year. Therefore, if you have multiple family members covered by the same insurance, the total bill for everyone might exceed $500. But before you start planning for the holiday dinners, consider that your co-pays would likely be lower if you were paying out of pocket.
A single office visit to see a specialist, for instance, can range between $100-$250. In addition to the actual cost of testing or treating allergies, you must factor in time spent traveling to and from the clinic, parking expenses and lost wages. As a general rule, if your annual income exceeds $50,000, you might want to think twice about opting for testing and treatment via insurance.

There are numerous factors to consider when deciding whether or not to undergo testing and/or treatment for allergies. First, if you suffer from severe allergies, you probably already know and understand what triggers them. So, regardless of the results of the testing, you are better off focusing on preventing exposure to those allergens. Second, if you live in a climate that allows you to spend most of the winter indoors, you may opt to forego testing and treatment and simply stop exposing yourself to outdoor allergens. Third, if you are employed full-time, you can expect to incur greater travel costs as well as missed hours from work during your visits to the doctor’s office. Finally, if you are currently uninsured, you may qualify for free testing and treatment through a state program called Medicaid.

For more information on allergies and related topics, please read the next page.

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