Allergy testing and immunotherapy schemes continue to pop up in primary care practices across the country, exposing patients and families to substandard diagnosis and treatment as well as raising the potential for fraud.
Here’s how it happens: Primary care offices enter into agreements with third-party companies whereby a “certified allergy technician” tests patients and recommends treatment. Patients are shuffled in for environmental and/or food allergy testing, and then offered immunotherapy, which may include either allergy shots or sublingual immunotherapy (SLIT) in which drops of the allergen are placed under the tongue. Many patients are unaware that SLIT is not currently approved by the U.S. Food and Drug Administration (FDA).
Meanwhile, patients are also unaware that these “certified allergy technicians” are not fully trained board-certified allergists. Many of the treatments recommended are inconsistent with established standards of practice designed to protect you as the patient. Some patients are even sent home with shots or drops to self-administer without fully understanding the risks.
Since SLIT is not FDA-approved, it is therefore not reimbursable by most health insurance plans. Many primary care practices, some unknowingly, bill insurance companies for SLIT. This is just one example of insurance billing fraud. Others: maximizing number of allergens to test for to maximize reimbursement; giving extremely low doses to avoid reactions, although reimbursement remains the same; repeat skin testing, which typically reveals no change; and billing SLIT as allergy shots.
What should I expect if I undergo allergy testing? Careful, thorough, knowledgeable and evidence-based care that includes:
What are my out-of-pocket costs for testing? Before scheduling an allergy testing appointment, check your medical policy to ensure you understand your insurance benefits. The Affordable Care Act requires most insurance companies to cover all costs of screening for allergy and asthma. Also, check your billing statement to ensure it is billed appropriately. Remember, immunotherapy drops under the tongue, or SLIT, are not FDA-approved and not reimbursable by most insurers at this time.
Allergy & Asthma Network Mothers of Asthmatics (AANMA) supports the role of primary care in the diagnosis and treatment of allergies and asthma, including the use of blood tests to identify potential triggers. Skin prick testing, however, requires specialized training to administer and interpret the tests and determine appropriate treatment.
What can you do to protect yourself? Learn to recognize the signs of deception in your primary care provider’s office.
Beware the bait and switch: If a visit to your primary care physician or any other doctor ends with a recommendation for allergy testing or immunotherapy, insist on a referral to a board-certified allergist.
A board-certified allergist is specially trained to identify the causes and symptoms of asthma and allergies. After earning a medical degree, the physician completes a three-year residency-in-training program in either internal medicine or pediatrics and then completes 2-3 more years of study in the field of allergy and immunology. You can be certain that a physician has met these requirements if certified by the American Board of Allergy and Immunology.
Recognize the risks: Allergy testing schemes deprive you of the personalized evaluation and care that a board-certified allergist provides and could leave you vulnerable to inappropriate treatment.
In addition, people can experience anaphylaxis, a severe and potentially life-threatening allergic reaction, as a result of allergy testing or immunotherapy. This should NOT be done at home; a board-certified allergist is best prepared to treat anaphylaxis.
— By Kimberly Turner, Esq.
Kimberly Turner, Esq., is Director of Government Affairs for Allergy & Asthma Network Mothers of Asthmatics.