Did you know, that if you are like so many of the men and women out there that need a wig for a medical reason (Cancer-related wig or Alopecia wig) you may be eligible for a reimbursement from your current health insurance provider? In fact, most insurance companies will cover between 80% and 100% of the purchase price of your wig.
The trick is knowing what insurance companies look for. A claim with the term “wig” will more than likely be rejected by insurance companies because it is seen as a cosmetic expense, while referring to the same product as a “Cranial Hair Prosthesis” will just as often result in a paid claim as a medical necessity.
How to File Your Initial Insurance Claim
- Receive a letter or prescription from your doctor for a “Cranial Hair Prosthesis.”
- Use the Healthcare Common Procedure Coding Systems (HCPCS) codes: S8095 and A9282.
- Have a receipt from the company where you purchased your Cranial Hair Prosthesis. Make sure it does not say “wig” anywhere and that it includes the HCPCS insurance codes. *WE CAN HELP WITH THIS*
- Also have the company include their Tax ID#.
- Have your physician sign off on the insurance claim form.
- Double check your insurance claim form to make sure you legibly included the following elements:
- The item “Cranial Hair Prosthesis”
- The HCPCS codes: S8095 and A9282
- The company’s Tax ID #
- Your physician’s signature.
Appealing a Denied Insurance Claim
- Know your rights and be informed. Obtain a copy of your full contract with your insurance company.
- Carefully read and understand the exclusions (“wigs”) and covered items (“Cranial Hair Prosthesis”) in your policy. See if your insurance policy calls it something other than “prosthesis.”
- Write a letter to the Medical Review Board asking for a review. Be sure to attach a copy of original claims.
- Emphasize that a wig is a cosmetic item and unnecessary. Prosthesis however, is necessary (comparable to plastic surgery for a burn victim).
- Address your letter to a supervisor in the Claim Department and ask for a written reply.
- Some other suggestions are:
- Include pictures of yourself without hair and a letter detailing the emotional effects your hair loss has had on your life
- Include a letter from your employer
Due to the differences in every individual’s insurance policy, this may not work for everyone. This guideline is just for you to reference and to show you how to research if your insurance company covers “Cranial Hair Prosthesis” or something similar. Make sure you review and understand the procedures outlined by your insurance policy as it may differ between carriers. Keep copies of all documentation including the receipt/invoice for your Cranial Hair Prosthesis (may even be a tax deductible medical expense).
- Apply for a Grant or Voucher up to $75 to cover your Cranial Hair Prosthesis (must apply before purchasing a wig)
- Apply for an allotment to cover the rest of the cost if your insurance company only covers a partial amount
- Financial Assistance for a Wig Purchase: 1-800-227-2345
National Alopecia Areata Foundation (NAAF)
- Pre-purchase program provides financial assistance to those who qualify