Insurance Coverage for Cranial Prosthesis

Several insurance companies offer coverage for medical wigs, also known as cranial prostheses, for individuals experiencing hair loss due to medical conditions or treatments.

Insurance Typically Covers Various Medical Hair Loss Conditions, Including:

Hair Loss from Alopecia
Hair Loss Associated with Chemotherapy
Hair Loss Due to Radiation Therapy
Hair Loss Linked to Thyroid Conditions
Hair Loss Resulting from Kidney Issues
Cancer-Induced Hair Loss
Hair Loss Attributable to Genetics, Stress, Medical Conditions, Life and Environmental Changes, Aging, Thinning, and Balding

Coverage for medical wigs/cranial prosthesis varies by insurer and policy, and it's essential to understand the specific terms and steps required to obtain coverage. Here is a summary of the insurance companies and their coverage for medical wigs, based on the information available:

Insurance Coverage for Wigs FAQ

Offers reimbursement for wigs as cranial prostheses under certain conditions, with a specific diagnosis code (A9282). The reimbursement rate for participating providers is up to $1,000.

Under individual plans, covers 80% if using an in-network provider, for therapy-related reasons such as chemotherapy. Prior authorization might be required for claims over $750.

Provides coverage for medical wigs in some plans, requiring a prescription and the use of an in-network medical prosthesis provider.

Some plans cover medical wigs, offering up to $40.00 reimbursement in a 12-month period, which must be paid out-of-pocket first.

Employer-sponsored plans may cover medical wigs at different percentages, requiring the use of an in-network provider.

Offers benefits for wigs due to cancer treatment at 100% of the billed amount, limited to $350 for one wig per lifetime. This coverage does not include cranial prostheses.

Requires a prescription with the diagnosis code A9282 for a cranial prosthesis to qualify for coverage of a medical wig.

Sunlife covers up to $500 lifetime maximum for Canadian residents outside of Quebec, requiring a doctor's prescription and receipt.
Manulife offers a benefit of up to $250 per year.
GMS: Some plans provide coverage for medical wigs.

Understanding Your Insurance Coverage with Us

At Model Lace Wigs and Hair, we understand the profound impact that medical conditions can have on your life, including the sensitive issue of hair loss. Our mission is to provide you with the highest quality medical wigs, offering a sense of normalcy and confidence during your treatment journey. We recognize the financial aspect of purchasing a medical wig and want to ensure you have a clear understanding of how insurance coverage works with us.

We are an Out-of-Network Insurance Provider: What It Means for You

We are an out-of-network provider for health insurance plans. This means that while we do not have direct billing arrangements with insurance companies, many of our clients successfully obtain reimbursement for their purchases from their insurance providers under their out-of-network benefits.

How to Seek Reimbursement

To obtain reimbursement for a medical wig, commonly needed by individuals experiencing hair loss due to medical conditions or treatments like chemotherapy, follow these general steps. The specific process can vary depending on your insurance provider, country, and healthcare system, but these steps provide a good starting point:

Steps	Description
Contact Your Healthcare Provider	If your policy includes coverage for a cranial prosthesis, inquire about the following: 1) The specific kinds of cranial prostheses eligible for coverage, such as synthetic wigs or human hair wigs. 2) The extent of cost coverage provided by the policy. 3) The precise language required on the prescription to qualify it for a wig. 4) The exact documents necessary for filing your claim. It's important to note that the absence of a mention of cranial prosthesis in your insurance policy doesn't necessarily imply lack of coverage. We strongly advise contacting your health insurance provider for pre-authorization to clarify this.
Doctor's Prescription	Obtain a prescription from your healthcare provider. The prescription should state that the wig is necessary due to medical reasons, such as alopecia or chemotherapy-induced hair loss. Use the term "cranial prosthesis" instead of "wig," as this emphasizes the medical necessity. Additionally, request that your physician write a letter detailing the impact of hair loss and emphasizing that the need for a cranial prosthesis transcends cosmetic purposes, aiming instead to support your emotional well-being.
Purchase a Medical Wig	If you are paying upfront to seek reimbursement, find a wig that suits your needs at ModelLaceWigsandHair. Keep in mind that insurance companies may only cover wigs up to a certain cost, so you might want to check coverage limits beforehand.
Keep All Receipts	Save all receipts and documentation related to the wig purchase. This includes the prescription from your doctor, the receipt from where you bought the wig, and any other related expenses.
Submit a Claim	Fill out your insurance provider's claim form, attaching the doctor's prescription, the receipt for the wig purchase, and any other required documentation. Ensure all forms are filled out correctly to avoid delays.
Appeal if Necessary	If your claim is denied, ask for a detailed explanation of the denial. Review your policy again to understand the basis of the denial and consider filing an appeal if you believe the wig should be covered. In the appeal, provide any additional information or documentation that supports the medical necessity of the wig.
Seek Assistance	If navigating the insurance process is challenging, consider seeking help from a patient advocate or a social worker. They can provide guidance and support throughout the reimbursement process.

Remember, insurance policies and healthcare regulations vary widely, so it's crucial to consult with your insurance provider and healthcare team for specific guidance. If you're not covered by insurance or if your claim is denied, there may be charitable organizations or grants that can assist with the cost of a medical wig.

This information is meant as a guideline, the suggestions here may not work for everyone. Make sure you review your benefits and coverage for your particular insurance carrier. Research the medical codes and conditions to see if you qualify.

Grants & Vouchers

American Cancer Society

Apply for a Grant or Voucher up to $75 to cover your Cranial Hair Prosthesis (must apply before purchasing a wig)/ You must meet certain financial guidelines and apply for this voucher before you purchase a hair system. They will not issue vouchers retroactively for purchases.

For more information, contact:

American Cancer Society
Call 1-800-227-2345
Website: http://www.cancer.org

National Alopecia Areata Foundation (NAAF)

This foundation has established the Ascot fund, which is a special pre-purchase program that provides financial assistance for individuals who have alopecia areata.

To find out if you qualify, please visit: