Burdensome and unreasonable requests from patients’ insurance companies for documentation regarding allergy immunotherapy services have threatened the ability of allergists/immunologists to administer allergen immunotherapy (AIT). AIT is a very cost-effective and well-established treatment for patients suffering from various (and often serious) allergic conditions. Insurance companies should pay for this service for their covered policyholders as promised, rather than delaying or denying payment. These unreasonable documentation requests and delay tactics pose a real risk to allergy specialists’ ability to continue offering this treatment, thereby hindering the ability of their patients to obtain relief. In response, the American College of Allergy, Asthma and Immunology (ACAAI) developed the Payer Education Campaign to help patients and the media understand how immunotherapy works, and provide guidance to insurance companies and other third-party payers regarding the treatment, why it is important, and why unnecessary payment delays jeopardize the treatment. The campaign also provides clear guidance to payers on what is appropriate vs. inappropriate documentation for these medical services.
ACAAI has reached out to several insurance companies in an effort to get a dialogue going, but has not had a response.
- News release: New Guidelines for Insurers Help Patients Receive Necessary Allergen Immunotherapy Treatment
- The 95165 Consensus Paper – “Guidance for the evaluation by payors of claims submitted using Current Procedural Terminology codes 95165, 95115, and 95117,” Annals of Allergy, Asthma & Immunology, January 2025.
- We’re knocking on United Healthcare’s door, March 7, 2025
- Letter to Anthem, December 9, 2024
Allergists David Stukus, MD, Nicole Chase, MD, and Cherie Zachary, MD, discuss why appropriate compensation for allergy treatment is so important.
Allergist J. Allen Meadows, MD, explains how insurance rejections affect patients.
Allergists Cherie Zachary, MD, and Travis Miller, MD, explain how allergists are specially trained to prepare allergy shots for each individual patient to treat their specific allergies.
Allergists Nicole Chase, MD, and J. Allen Meadows, MD, explain how allergy shots work and how can they help change your immune system to deal with your allergies.
