For clinic visits, many insurance providers require authorization prior to your appointment. If your insurance provider requires prior authorization, you will need to submit an authorization form and proper documentation to them before your appointment can be scheduled. Please contact your insurance provider directly for any questions about prior authorizations and the forms required. You will need to have your primary care physician submit this form on your behalf.
Table Of Contents
Obtaining a referral
For a HMO / EPO plan:
When you have a HMO / EPO plan, your primary care physician (PCP) will be your first point of contact. Your PCP will forward a referral for the Tolerance Induction Program™ to your insurance provider on your behalf.
*Getting a referral does not guarantee your plan will cover the cost of services. However without a referral, you could end up paying for more or all of the treatment cost.
Steps to request a referral / prior authorization:
- Step 1 – Visit or contact your primary care physician. Your primary care physician will evaluate your concerns and make a referral to our program to your insurance provider. Most medical groups / offices have a special referral department that will handle this request and any questions you have. For your initial visit please request a referral for the following CPT codes:
- Office Visit New Procedure 99205 Qty 1
- Skin Test (SPT) Procedure 95018 Qty 19
- Step 2 – Verify your PCP has forwarded the referral to your insurance provider.
- Step 3 – Verify your insurance provider has received the referral from your PCP. Call the number on the back of your insurance card and tell them you are checking the status of a referral / prior authorization.
- Step 4 – Once your health plan has approved the referral, they will forward an authorization to the Food Allergy Institute. Verify your insurance provider has sent a copy of the referral approval to [email protected]
- Step 5 – Allow 3-5 business days for authorizations to be reviewed by our billing department. Once billing has processed the authorization, we will contact you to complete the enrollment process and schedule your first appointments.
**Please be advised, the process of obtaining referral and/or prior authorization can take up to 30 days on average.
Requesting A Status Update
Before requesting a status update on your referral or prior authorization, please confirm you’ve completed each of the following steps:
- Obtained a referral and/or prior authorization from your primary care physician
- Verified your insurance provider has received the referral and/or prior authorization from your PCP
- Verified a copy of the referral and/or prior authorization approval has been sent to [email protected]
FAQs
Is my insurance company in-network with The Food Allergy Institute / LAHA?
Because each insurer offers a number of plans, we recommend contacting your insurance company or completing our insurance verification form to confirm coverage prior to enrolling in the program. Call your insurance company today and provide the following information:
*For Cigna & Aetna
TPIRC Medical Foundation, Inc.
701 E. 28th Street, Suite 419 Long Beach, CA 90806-2759
NPI: 1225611312
Tax Id: 86-3638185
For All other Plans
Lung & Allergy Health Associates
2801 Atlantic Ave, Long Beach, CA 90806
NPI: 1972126662
Tax ID: 84-4487213
What is LAHA?
Lung & Allergy Health Associates (LAHA) is a coordinated team of dual-boarded pediatric pulmonologists, allergists, and immunologists supporting healthcare groups, including The Food Allergy Institute. In affiliation with Miller Children’s & Women’s Hospital / Long Beach Memorial Center, LAHA uses a multidisciplinary approach to target the needs of all patients. Insurance claims for Food Allergy Institute visits are processed under LAHA. *Foundation Labs claims are processed under Foundation Labs.
How do I contact my insurance company?
Call the phone number on the back of your insurance card. Some companies provide apps or chat for ease of access.
Important information about referrals
Referrals need to come from your current PCP if you want your plan to cover or help pay for your care when:
- A specialist refers you to another specialist.
- Going to see a specialist who’s not in your plans network.
- You were seeing a specialist before enrolling in an HMO plan and you want to continue seeing that specialist.
- If you change your PCP while getting care from the specialist, your new PCP may need to issue a new referral.
Other Information About Referrals
- Referrals have an expiration date. You’ll have anywhere from 90 days to one year to see the doctor you were referred to, depending on the specialty.
- In-network services for HMO patients will always be responsible for copayments, and the deductible and coinsurance if applicable.
- Out-of-network HMO or EPO, will typically not be covered for any out-of-networks services unless it is an emergency.
Insurance Carrier Contract List
The Food Allergy Institute currently participates with the following insurance carriers:
- Aetna (California Region)
- Anthem Blue Cross (California Region)
- Blue Shield (California Region)
- Cigna (California Region)
- Health Net (California Region), United Healthcare (California Region)
Please contact your insurance carrier directly to determine if the Food Allergy Institute is within your network and considered a participating provider under your plan. To assist you with this verification, please see the Billing Entity, Service List, and Fee Schedule to obtain the billing entity information.
Billing Entity, Service List, and Fee Schedule
This document outlines the billing entity, types of visits performed at the Food Allergy Institute and associated fees.
TMF Billing Entity *CIGNA & AETNA
| Billing Entity | TPIRC Medical Foundation, Inc. |
| NPI | 1225611312 |
| Tax ID | 86-3638185 |
| Address: | 701 E. 28th Street, Suite 419 Long Beach, CA 90806-2759 |
| Lockbox / Remittance Address: | PO BOX 2246 Seal Beach, CA 90740-2759 |
Visit Types and Fee Schedules
Onboarding (Visit #1)
| Description | Procedure | Units | Fee |
| Office Visit, New | 99205 | 1 | $450.00 |
| Skin Test (Skin Prick Test) (SPT) | 95018 | 19 (*MUE) | $50.00 |
Launch (Visit #2)
| Description | Procedure | Units | Fee |
| Office Visit, Established | 99215 | 1 | $240.00 |
| Food Challenge | 95076 | 1 | $195.00 |
| Patch Test | 95044 | 25 (varies per allergen) | $25.00 |
| Spirometry | 94010 | 1 | $120.00 |
| Exhaled Nitric Oxide Test (ENO) (children age 7+ only) | 95012 | 1 | $40.00 |
Challenge Visits (All Other Visits)
| Description | Procedure | Units | Fee |
| Office Visit, Established | 99215 | 1 | $240.00 |
| Food Challenge | 95076 | 1 | $195.00 |
Annual Remission Visit (In-Person or Virtual)
| Description | Procedure | Units | Fee |
| Office Visit, Established | 99215 | 1 | $240.00 |
Other Services (As Needed)
| Description | Procedure | Units | Fee |
| Office Visit, Established | 99215 | 1 | $240.00 |
| Allergen Injection (2 or more) | 95117 | +2 | $75.00 |
| Prophylactic, Therapeutic Injection | 96372 | Per injection | $40.00 |
| Skin Test (Skin Prick Test) (SPT) | 95018 | 19 (*MUE) | $50.00 |
| Patch Test | 95044 | 25 (varies per allergen) | $25.00 |
| Spirometry | 94010 | 1 | $120.00 |
| Exhaled Nitric Oxide Test (ENO) (children age 7+ only) | 95012 | 1 | $40.00 |
Foundation Labs Billing Entity
| Billing Entity | Foundation Labs |
| NPI | 1639642564 |
| Tax ID | 83-0653027 |
| Laboratory Address: | 701 E. 28th St., Suite 317, Long Beach, CA 90806 |
| Payment Address: | Mailstop: 96530421, PO BOX 660535, Dallas, TX 75266-0535 |
Contact Information
| Change Healthcare | (Billing Vendor as of 9/14/2020) |
| Phone Number | 866-500-9722 |
| MCCB | (Billing Vendor prior to 9/11/2020) |
| Phone Number | 800-719-0840 |
| Foundation Labs Customer Service | 562-490-9900 |
Financial Responsibility for Families – Deposit
| PPO, Medicaid, Private, Other | $500.00 due at the time of the appointment |
| HMOs and Kaiser Insurance | $1000.00 due at the time of the appointment And $1500.00 due within 4 months, per lab visit |
| Cash Patient | $1000.00 due at the time of the appointment And $1500.00 due within 4 months, per lab visit |
| International Patients | $2500.00 due at the time of the appointment |
Laboratory Services and Fee Schedules
| Description | Procedure* | Units | Fee/Charge | Total Fee |
| Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each | 82784 | 1 | $34.40 | $34.40 |
| Gammaglobulin (immunoglobulin); IgE | 82785 | 1 | $34.40 | $34.40 |
| Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each | 82787 | 4 | $168.00 | $672.00 |
| Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified | 83520 | 4 | $139.00 | $556.00 |
| Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count | 85025 | 1 | $28.75 | $28.75 |
| Allergen specific IgG quantitative or semiquantitative, each allergen | 86001 | 11 | $23.45 | $257.95 |
| Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each | 86003 | 41 | $19.25 | $789.25 |
| Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, each | 86008 | 64 | $67.30 | $4307.20 |
| Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker | 88184 | 1 | $200.00 | $200.00 |
| Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker (List separately in addition to code for first marker) | 88185 | 2 | $800.00 | $800.00 |
| Totals | $7679.95 |
- For allergen panel details, go to Foundation Labs Allergen Panels
Services listed above are the recommended baseline laboratory tests and subject to change based on the
treatment plan. Out-of-pocket costs will vary based on benefits and determined after the claim has been
processed by the insurance carrier.
Please confirm with the insurance plan if an authorization is required, please note, an authorization is not a guarantee of payment. A family’s maximum Out-of-Pocket Cost is not to exceed $2500.00.