What is an Allergist - Immunologist?

 

An allergist/immunologist is a physician with initial training in either internal medicine or pediatrics (3 or more years) followed by further training in allergic and immunologic diseases (an additional 2 or more years). It is very important that an allergist/immunologist be board-certified since it means that your physician has passed rigorous examinations to practice the sub-specialty. Before being able to take the Allergy and Immunology Board Examination, your physician must first pass the board examination in Internal Medicine or Pediatrics. All doctors in our group are certified by the American Board of Allergy and Immunology.

 

Who should see an allergist?

 

• Those with inadequately controlled symptoms.

• Those who need to identify specific allergens that they are sensitive to in order to help with avoidance steps.

• Those with reduced quality of life or functional abilities due to allergies.

• Those who are considering allergy immunotherapy for more long-term control.

• Those with comorbid conditions such as asthma, sinusitis, frequent ear infections or eczema.

 

What should I bring to my first appointment?

 

• Current insurance card(s) including prescription drug card(s)

• Co-payment

• Completed new patient paperwork: Lincoln forms   Omaha forms

• Current medications/supplements (or a list with strength and dosage)

• Copies of available medical records pertaining to the symptoms for which the appointment was made

 

How long does the initial appointment take?

• You should plan to spend approximately one or two hours at our office for your evaluation. Please arrive 15 minutes prior to your appointment for check-in.

 

Will my insurance cover immunotherapy?

 

This is a common question and a very difficult one to answer. There are several insurance companies and most carriers have many different policies that employers can choose from for their employees.

 

Insurance companies are not required to disclose the amounts that are covered and the amounts that the patient will be responsible for to the provider of service. Therefore, it is difficult for us as the provider to determine whether or not immunotherapy is a covered service for you. We encourage you to contact your insurance company personally to find out about immunotherapy coverage. When contacting your insurance company, please provide them with the codes listed below.

 

There are two kinds of fees associated with immunotherapy administration:

1. Code 95165 is used for preparation of allergy extract. Vials of serum last approximately 10 weeks depending on your frequency.

2. Code 95115 (one shot) or 95117 (two or more shots) is used for the administration of injections and is billed each time you receive your injections.

 

Questions to ask your insurance company:

1. Is Immunotherapy a covered service?

2. Would my extract (95165) be subject to a deductible or copay?

3. Would my shots (95115 or 95117) be subject to a deductible or copay?

4. Is there a yearly maximum for immunotherapy under my plan?

 

We hope this information helps answer some of the questions you may have concerning coverage of immunotherapy. It is always helpful to document who you spoke with when you call your insurance company for future reference.

 

If you have questions or concerns, please feel free to contact our office.

 

Payment for Professional Services

 

The office asks that co-payments be made at the time of service. Statement will be printed on the 1st of each month.

 

If clearing the balance within 90 days is not possible, please contact our office. We will arrange a payment schedule with you. We also accept MasterCard, Visa, American Express and Discover for your convenience.

 

If we participate with your insurance carrier, our office will submit the charges. In most cases, your insurance is a contact between you and the insurance company. If we do not participate with your insurance company, it will be your responsibility to submit the charges. You may submit charges with one of the following forms:

• The itemized statement we can provide at the end of your appointment.

• The itemized billing statement you receive after the 1st of each month.

• A computer print-out of charges. You may request the itemized print-out of charges from our office.

 

Our doctors participate and accept assignments with Medicare. If you are on standard Medicare or Medicare Advantage, we will automatically submit your charges to the insurance carrier. If you receive payment from your supplemental insurance company you will need to send that payment directly to us.

 

Any co-payment, deductible, or remaining balance after the claim has been processed is YOUR RESPONSIBILITY.