Deception In Allergy Care: Recognize the Signs of Fraud
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 fraudulent billing. But there are deceptions too and here is how to recognize the signs of fraud.
Here’s how it happens: primary care offices enter into agreements with third-party companies whereby a “certified allergy specialist” 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 and, therefore, not typically reimbursable by insurance.
Meanwhile, patients are unaware that these “certified allergy specialists” are not formally trained allergists. Many treatments recommended are inconsistent with established standards of practice designed to protect you as the patient. Jim Wallen, expert in allergy extract testing and immunotherapy states, “Because drops are not FDA-approved, they are typically not reimbursable by health insurance. Yet many primary care practices, some unknowingly, bill insurance companies. This is just one example of insurance billing fraud. Others include maximizing the number of allergens tested in order to maximize reimbursement; giving extremely low doses to avoid reactions, although reimbursement remains the same; and treating with a universal stock mix that contains many allergens a patient is not allergic to."
Many of these “certified allergy specialists” have no previous medical experience whatsoever and are given quotas for the number of patients they must test and put on allergy shots or risk losing their job.
Allergy & Asthma Network Mothers of Asthmatics (AANMA) believes there is a role for allergy testing in primary care practices – but that it should be limited to blood testing in order to minimize the potential for patient harm.
What can you do to protect yourself? Learn to recognize the signs of deception in your primary care provider’s office.
Beware of 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.
According to Dr. Maeve O’Connor of AAIR Charlotte, “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 only 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 this serious response.
Ask Questions About Allergy Signs and Undergoing Testing
What should I expect if I undergo allergy testing? Careful, thorough, knowledgeable and evidence-based care that includes:
- A complete history of your allergy symptoms and allergies in your family
- Appropriate allergy tests: skin, blood or challenge tests
- Properly interpreted test results by a trained specialist
- Any other tests, such as a physical exam, that are necessary
- A detailed treatment plan that consists of allergen avoidance, possible medication, and/or immunotherapy
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 tests. Also, check your billing statement to ensure it is billed appropriately. Remember, immunotherapy drops under the tongue are not FDA-approved and not reimbursable by most insurers at this time.
Tonya Winders is the President & CEO of Allergy & Asthma Network Mothers of Asthmatics.