If your need for a wig is due to hair loss caused by an underlying medical condition it may be covered by your health insurance. However complicated, we’ve compiled steps to help you through the process of submitting a claim for your wig with the insurance company.
Cranial Prosthesis/ Hair Prosthesis.
The medical insurance world is driven by some very specific diagnosis codes that determine coverage. A wig is not considered to be a covered item but a “cranial prosthesis” or a “hair prosthesis’ for medical hair loss related to conditions such as alopecia areata, alopecia totalis, trichotillomania is considered eligible. Similarly temporary hair loss resulting from chemotherapy, radiation therapy or some specific cancer diagnosis codes are also considered to be covered or partially covered items. The insurance company will require a carefully worded prescription from a doctor and include terms such as “Cranial Prosthesis” or “Hair Prosthesis”.
Does my insurance provide coverage?
Approximately 40% of insurance companies provide some form of coverage for a cranial prosthesis depending on the condition. It depends on which policy you have and who your carrier is and it is critical that you research this in advance of any purchase. It should be noted that Medicare does not provide coverage for cranial prosthesis and neither do most Medicare Advantage plans. Some insurance companies will cover between 80-100% of the cost for your full cranial prosthesis and will allow you to receive one cranial prosthesis per year for medical hair loss.
How to verify coverage.
The best way to verify coverage is to call your Health Insurance Provider’s Benefits Services phone number on the back of your insurance card. Here are the questions to ask.
- Does my policy cover a cranial prosthesis and what type? (human hair or synthetic wigs.)
- What portion of the cost is covered and what is the maximum?
- What is the exact phrasing and wording you need to have on the doctor’s prescription for the coverage to be approved… write it down exactly as stated.
- What documentation (receipts, prescription, claim form etc) do you need to submit along with your claim.
In most cases, you will have to pay for your wig upfront and then get reimbursed after you submit a claim to your insurance company. Typically, you’ll need to send your insurance company a prescription from your doctor for a “cranial prosthesis” or a “hair prosthesis” (with a cancer diagnosis code), the receipt for the wig (with the wig company’s tax ID number), and a completed insurance claim form.
Wig Company Receipt
It is critical that the receipt received from the Wig Retailer must mention “Cranial Prosthesis or Hair Prosthesis” and also include Retailer’s Tax Id. LA Wig Company can provide this on request.
Is your Wig Purchase covered by Insurance? Wigs required for certain medical conditions can be covered by medical insurance but not all. It is critical to research your coverage by calling the insurance carrier and be sure to use the term “Cranial Prosthesis” or “Hair Prosthesis” in all conversations. This term must also be referenced by the supporting doctor’s prescriptions and receipt from the wig retailer.
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