Posted on November 10 2018
Will Insurance Cover the Cost of a Medical Wig?
If you have a medical condition such as Alopecia, Trichotillomania or you’re a cancer patient looking for a chemotherapy wig for hair loss, you may have insurance coverage to offset the cost of your medical wig.
Call Your Health Insurance Provider First
Most private health insurance policies will cover a percentage of a wig purchase. Before you start wig shopping, call your insurance company and ask about their requirements, what they will cover, and what terminology they need to have on a prescription for a wig.
Because wigs for cancer patients and other health conditions, are not for cosmetic purposes, they may qualify for reimbursement covered by your health insurance. Many private insurance companies now cover all or some of the cost of a medical wig as long as you have a prescription. It’s not uncommon to receive reimbursement of 80-100% of the cost of a medical wig.
It’s important to know that in order to qualify, most insurance companies, require a qualifying medical diagnosis given by your treating physician which could make you eligible for reimbursement for your medical wig also called Cranial Prosthesis. The insurance company may also require that you purchase the wig first, send in the receipt, and file a claim.
When looking over your insurance policy to verify your coverage the information will likely be listed under the section called: Durable Medical Equipment.
Note: Just because you don’t see cranial hair prosthesis listed, it does not automatically mean you don’t have coverage. Approval can be obtained by calling your insurance company and getting a pre-authorization.
When filing your claim for insurance coverage for your medical wig, it’s vital that you use the correct terminology and diagnosis codes assigned by your prescribing physician when submitting your reimbursement claim.
Some common terms for medical wigs include:
- cranial prosthesis (CP)
- hair prosthesis
- cranial hair prosthesis
- extra-cranial prosthesis.
FILE FOR INSURANCE
Follow the instructions below to file an insurance claim for your wig / medical hair prosthesis.
STEP 1. Pre-Authorization (Get Pre-Approved)
Approval can be obtained by calling your insurance company and getting a pre-authorization. Call your insurance company and ask about their requirements, what they will cover, and what terminology they need to have on a prescription for a wig.
Search our website for the wig you like to get a cost estimate, then ask your insurance provider how much they will reimburse you for your medical hair prosthesis, and how long it will take to get reimbursed.
STEP 2. Purchase Your Wig
Choose a repeatable wig shop that is able to meet your medical wig needs.
Step 3: File a Claim
Download and send Claim Form #1500 to your insurance company (contact your provider if the form is not listed below). Other items you will need include:
- Our Federal Tax ID: #
- Procedure Code from your insurance provider. Commonly used procedure codes: Synthetic Wig (A9282 or 99199); Human (L8499)
- Receipt paid in full as proof of payment
- Prescription (Rx) with your diagnosis code from your doctor (It must be written for a medical or cranial hair prosthesis)
Ask for Assistance to Find Out if You’re Covered!
Many wig shops offer free consultations as well as services to help you get through this process. I hope this has helped you understand what steps are needed to get you started. Feel free to contact us with any questions you may have.