Before you visit an allergist, it is important you understand your insurance benefits.
The information we receive may not always have your most accurate and updated benefit coverage, and we strongly suggest our patients contact their insurance provider’s member services department before coming to see the doctor. Be clear on what your individual plan covers before you visit.
What you will need:
- Your insurance card. Phone number for member services is located on the back of the card.
- Policy holder’s name and date of birth.
- Your doctor’s name and office address.
What to Ask:
Explain to the representative that you are planning to visit a specialist. Specifically Hudson Allergy, your allergist.
1. Confirm that we are in network with your insurance plan.
2. Ask about coverage for:
- Office visit with a specialist allergist;
- Allergy testing performed in the office;
- Allergy injections and treatment;
- Contracted prices for the above services (only if you have deductible).
If services are subject to your deductible you may want to request prices for such services.
Below are Services and Procedure Codes to help you obtain contracted price from your insurance company.
|Service||Procedure Code (CPT)|
|New Patient consultation||99203 or 99204|
|Spirometry||94010 and 94060|
Network—The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
Deductible—The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.
Coinsurance—the amount you pay to share the cost of covered services after your deductible has been paid. The coinsurance rate is usually a percentage. For example, if the insurance company pays 80% of the claim, 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., $10 for every visit to the doctor), while your insurance company pays the rest.
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.