What are your rights?
Until the Affordable Care Act goes into effect in 2014, there are no federal acts in place to ensure those suffering from allergies receive treatment.
What problems might you run into?
“It’s pretty standard that insurance companies will cover all of the prescribed medications for treating allergies, at least at some level,” says Dr. Michael Foggs, American College of Allergy, Asthma, and Immunology’s board member and past chair of the Managed Care and Health Plans Committee. “Although, one thing to watch out for is that so many allergy medicines are now available over-the-counter, meaning those aren’t covered by insurance anymore.”
If your doctor needs to perform any procedures on you, ask them to write down the codes and call up your insurance company to make sure they’re covered beforehand. “It’s not your allergist’s responsibility to know what your insurance company is going to cover,” says Dr. Sakina Bajowala, a fellow at the American Academy of Allergy, Asthma, and Immunology. “That is something you need to be in charge of.”
How can you save money on treatment?
“Allergies are chronic conditions, so they can get pricey to treat,” says Dr. Bajowala. “But that said, there are ways to save money in both the short-term and long-term.” One of your immediate concerns is going to be how to save money on medicine. Over the past few years, the majority of oral allergy medications like Claritin, Zyrtec, and Allegra became available in both generic forms and over-the-counter.
“The generic versions of these drugs are just as good as the brand names and can save you a lot of money,” says Dr. Bajowala. She suggests shopping at big discount stores like Sam’s Club and Costco. Many use these types of drugs as a loss leader, meaning they barely mark them up at all as a way to bring people in the door.
While you may be tempted to also get an over-the-counter nasal spray, Dr. Bajowala recommends against that. “The most effective nasal sprays are prescription only,” she says. “But you don’t need to go out and have your doctor prescribe the newest name brand one. A lot of these have gone generic as well, so ask for that option to make sure you have the lowest copay.”
As for eye drops, Dr. Foggs has a similar caution. “The best type of eye drops are gotten with a prescription and, at the moment, brand name,” he says. “But with eye drops—and any other prescription medication—some pharmaceutical companies have plans that discount the medications to patients who are in low income brackets. You’ll usually need to provide a financial statement and have verification from your doctor that you need the medicine.”
Also look online at needymeds.com for coupons for prescribed medications. It sounds strange, but you can get major discounts that will help with the cost if you don’t have insurance.
“The other way to get free medication is to ask your doctor for a sample,” says Dr. Foggs. “Pharmaceutical representatives leave lots of samples with doctors and he won’t mind giving you one. That way you won’t waste money on pills or sprays that aren’t going to be effective for you.”
Besides medications, you’re likely also going to have skin tests done to find out what exactly it is you’re allergic to. “This is covered, but if you don’t have insurance, most allergists will be happy to work out a cheaper rate with you—especially if you can pay in cash and up front,” says Dr. Bajowala. “Most doctors don’t get their full rate from insurance companies anyway, so don’t feel bad asking.”
While those strategies will help you save money in the short-term, there are two things you can do today that might help you financially over the long-term. One is to pay the higher copay to visit the allergist as opposed to self-medicating yourself with over-the-counter drugs. “That way, you won’t spend unnecessary money on medication that may not be the best for your allergies,” says Dr. Foggs. “And the allergist will be able to pinpoint your specific triggers, so you can focus your energy (and money) on the things that will be most likely to help you.”
The other option you can explore with your allergist is a process called allergen immunotherapy.
“That’s a series of shots given over the course of three to five years,” says Dr. Bajowala. “They can be very cost effective in the long-term because they can result in you not requiring any medication for up to 10 years after treatment.” The shots are often covered by insurance, but if you have a high-deductible plan, start your series in the second half of the year. “When you start the process, you get the shots more regularly, so you’ll save if you start it after your deductible has been met,” says Dr. Bajowala.