The following three areas are NOT considered routine in relationship to allergy shots, testing or desensitization.
• Severe Chronic Sinusitis not responsive to antibiotics, antihistamines or decongestants
• Asthma, triggered or worsened by allergies and not adequately responding to usual treatments
• Anaphylaxis and angioedema
In order to obtain a referral to an allergy specialist, students should forward any provider notes from a previous physician or allergist related to evaluation and treatment of an allergic condition. This may include provider visit notes, allergy testing results, injection history, and immunotherapy prescriptions from the allergist.
SHCS will review the patient's notes and make a referral to an Allergy specialist as medically necessary.
At that time, SHCS will attempt to ascertain if the student's allergic condition will fall into a criteria that will allow for insurance coverage.
If the student's allergic condition is documented to be one of the conditions listed above, the visit should be covered by insurance (according to the benefits of the plan as described in the insurance brochure, this does not automatically translate to 100% coverage).
If the student's condition falls under an exclusion (routine allergy testing and desensitization, as stated by the insurance brochure, see Exclusions section, the student will have to pay for all related services once referred.