Allergy immunotherapy is one of the few treatments that can modify the underlying allergic disease — appeal your denial.

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Understanding Your Allergy Immunotherapy (Allergy Shots or Sublingual Tablets) Denial

Allergy immunotherapy — whether subcutaneous (allergy shots) or sublingual (under-the-tongue tablets) — is one of the few treatments that can modify the underlying allergic disease rather than just managing symptoms. Despite decades of evidence and endorsement by major medical societies, insurers deny immunotherapy claims citing insufficient documentation, questioning medical necessity, or imposing step therapy requirements. A well-documented appeal can overturn these denials.

Common Reasons for Denial

  • ! Not medically necessary
  • ! Must try other medications first (step therapy)
  • ! Insufficient documentation of allergy testing
  • ! Treatment duration exceeds plan limits
  • ! Sublingual immunotherapy considered experimental
  • ! Out-of-network allergist
  • ! Prior authorization not obtained

How We Help

We help you document your allergy history, failed medication trials, skin test or blood test results, and the clinical rationale for immunotherapy as the appropriate next step.

Start your allergy immunotherapy appeal — it takes about 3 minutes.

Some Types of Evidence We Can Use For Supporting Your Appeal

✓ Allergen immunotherapy is recommended by the American Academy of Allergy, Asthma & Immunology (AAAAI) and the World Health Organization (WHO) as the only disease-modifying treatment for allergic rhinitis and allergic asthma.

✓ Studies demonstrate that immunotherapy reduces medication use, prevents new sensitizations, and decreases the risk of developing asthma in patients with allergic rhinitis.

✓ Discontinuing immunotherapy before completing the recommended 3-5 year course significantly increases the risk of symptom relapse and loss of therapeutic benefit.

Patient Advocacy & Support Organizations

These organizations provide education, support, and advocacy for patients:

American Academy of Allergy, Asthma & Immunology (AAAAI) ↗

Patient education and clinical guidelines for allergy immunotherapy.

Asthma and Allergy Foundation of America (AAFA) ↗

Resources on insurance coverage, patient advocacy, and understanding immunotherapy options.

Frequently Asked Questions

Common reasons include claiming you haven't tried enough medications first, questioning whether your allergies are severe enough, or considering sublingual immunotherapy experimental. All of these can be challenged with proper documentation.

We recommend including them. Skin prick tests or specific IgE blood tests showing sensitization to the allergens being treated are strong supporting documentation. However, depending on your situation — for example, if you have a well-documented clinical history of allergic reactions — your appeal may succeed with other evidence. Your appeal should include whatever testing and clinical documentation you have available.

Several sublingual immunotherapy tablets (Grastek, Ragwitek, Odactra) are FDA-approved. Practice parameters from the American Academy of Allergy, Asthma & Immunology support both subcutaneous and sublingual immunotherapy as evidence-based treatments.

Standard treatment is 3-5 years. Insurers sometimes deny continuation after the first year, but guidelines recommend completing the full course for lasting benefit. Your appeal should reference these guidelines.

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Disclaimer: Fight Health Insurance is not affiliated with, endorsed by, or partnered with any pharmaceutical manufacturer, healthcare provider, medical device company, or patient assistance program. All information provided is for educational and informational purposes only and does not constitute medical or legal advice. Please consult with your healthcare provider regarding treatment options and with your insurance company regarding coverage decisions.