What to Know About Your Insurance Coverage Before Seeing Your Allergist

Before your upcoming visit with an allergist / immunologist, it is important to understand your health insurance coverage. While many medical practices may assist in checking your benefits, it is ultimately your responsibility as the patient to understand the details of your insurance plan. This is because your health insurance policy is a contract between you and your insurance provider, not the medical office.

Here are a few key points to review before your appointment:

1. In-Network vs. Out-of-Network
Make sure your allergist is in-network with your insurance plan. If the provider is out-of-network, you may be required to pay a significantly higher portion of the costs out of pocket.

2. Deductibles
Check if your plan includes a deductible, the amount you must pay out of pocket for healthcare services before your insurance begins to cover costs. Deductibles can range from a few hundred to several thousand dollars. Until it is met, you may be responsible for 100% of the service fees.

3. Co-pays
A co-pay is a fixed amount you pay for specific healthcare services such as office visits, specialist appointments, emergency room visits or prescriptions. These fees usually apply even after your deductible is met, and typically range from $20 to $100.

4. Co-insurance
Co-insurance is the percentage of costs you are responsible for after your deductible has been met. For example, with an “80/20” plan, your insurance covers 80% of the cost, and you are responsible for the remaining 20%.

5. Coverage vs. Out-of-Pocket Costs
When contacting your insurance provider, keep in mind that asking whether a service is "covered" can be misleading. Even if a service is covered, you may still be responsible for co-pays, co-insurance or unmet deductibles.

6. Requesting Cost Estimates
Once you are familiar with your insurance details, consider requesting cost estimates. Ask your allergist’s office for the CPT (Current Procedural Terminology) codes commonly used for:
•  New patient visits
• Follow-up visits
• Skin testing
• Spirometry and other procedures

You can then contact your insurance company to get an estimate of your financial responsibility for each service.

Final Tip:
While your allergist / immunologist is focused on your medical care, insurance policies can be complex and not always transparent to the provider’s office. By taking the time to understand your plan and prepare financially, you will help ensure a smoother, more informed healthcare experience.

The AAAAI's Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.

6/2/2025