Goal:
To understand your insurance benefits, before your first visit with your allergist.
The information that we have may not always be the most up to date coverage information. It is your responsibility to understand how your individual plan covers before your visit.
It is strongly suggested that our patients contact their insurance provider’s member’s services.
Getting Started:
What you will need is your:
- Insurance contact number: back of current insurance card
- Policy holder’s name and date of birth
- Doctor’s that you are seeing
What to Ask:
Talk with the representative that you are going to see an Allergist.
- Confirm that we are in network with your insurance plan
- Ask about coverage for:
- Allergy testing performed in office
- Allergy Serum Extract
- New Patient Consultation
- If you have a deductible, your deductible is subject to the contractual prices for the above. To investigate contractual prices for certain services/procedure codes you can ask the allowable amount for
| Service | Procedure Code (CPT) |
| New Patient consultation | 99203 or 99204 |
| Allergy testing | 95004 x (40 tests/80 tests) |
| Serum (Vials) | 95165 x 24 units |
Insurance Terms:
Coinsurance – your share of the cost of a covered service after your deductible has been paid. The coinsurance rate is usually a percentage. For example, if the insurance company pays 80% of the allowable insurance amount, you pay 20%
Copayment – one of the ways you share in your medical costs. You pay a flat fee for certain medical expenses (e.g., $15 for every visit to the doctor), while your insurance company pays the rest.
Deductible – The amount you pay for covered health care services before your insurance plan begins to pay. With a $1,000 deductible, for example, you pay the first $1,000 of covered services yourself. After that, you share the cost with your plan by paying coinsurance
Network – The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
Out-of-pocket maximum – the most money you will pay during a year for coverage. It includes deductibles, copayments, and coinsurance, but is in addition to your regular premiums. Beyond this amount, the insurance company will pay all expenses for the remainder of the year.