Allergy Shot Out-of-Pocket Planner

Project your annual allergy shot budget by blending contracted rates, deductibles, and per-visit cost sharing. Enter the number of injections, the allowed charge per visit, and your plan's coinsurance to see total patient spend, insurer reimbursement, and the average amount you will pay per appointment.

Include both build-up and maintenance injections scheduled for the plan year.
Contracted amount for the injection and administration fee.
Percentage the plan pays on covered charges once the deductible is met.
Optional. Defaults to $0 if you have already met the deductible.
Optional. Defaults to $0 if your plan only uses coinsurance.
Optional. Enter the yearly vial preparation fee if it is billed separately.

Actual reimbursement depends on your specific insurance policy and provider contracts. Verify benefits with your insurer before committing to treatment.

Examples

  • 36 visits, $85 allowed charge, 80% coinsurance, $400 deductible remaining, $15 copay, $350 serum fee ⇒ Patient out-of-pocket: $1,542.00 • Insurer payments: $1,868.00 • Average patient cost per visit: $42.83.
  • 24 visits, $95 allowed charge, 90% coinsurance, optional fields blank ⇒ Patient out-of-pocket: $228.00 • Insurer payments: $2,052.00 • Average patient cost per visit: $9.50.

FAQ

How do I adjust for split billing between serum and administration codes?

Include the sum of the allowed amounts for both line items in the per-visit charge. If your provider bills serum separately once or twice per year, place that amount in the serum fee field so it is only counted once.

Does this calculator handle out-of-network charges?

The math assumes allowed, in-network rates. For out-of-network claims, replace the per-visit charge with the amount your plan recognizes and add any balance bill manually to the result.

What if my plan charges a different copay during build-up versus maintenance?

Average the copays across the year or run two scenarios—one for build-up visits and another for maintenance visits—to understand the blended impact.

Additional Information

  • Deductible dollars are applied before coinsurance is calculated, so fewer visits may be covered entirely out of pocket early in the year.
  • Serum preparation fees are treated as covered services when entered, but confirm whether your clinic bills them separately or annually.
  • Copays stack on top of deductible and coinsurance obligations when your plan uses hybrid cost sharing.

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