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Insurance Coverage for Cranial Prosthesis

 

Your health insurance can reimburse you 80%-100%

Did you know that many health insurance companies could reimburse you the full cost of your human hair wig or hair topper? Valid medical conditions for “Cranial Hair Prosthesis” include Alopecia or Cancer. There is hope to look good and feel better once again with a human hair wig or hair topper. Let us help you find a solution for your hair loss struggles.

INSURANCE COVERAGE

When dealing with insurance companies it’s very important to consistently use the term “Cranial Hair Prosthesis” and NOT a “Wig”. A claim submitted with the term “Wig” will get denied because a wig is for cosmetic purposes. Referring to the same product with the term “Cranial Hair Prosthesis” which is necessary for medically related hair loss will result in a paid claim as a medical necessity. Double check your insurance benefits and coverage to ensure “Cranial Hair Prosthesis” is covered.


HOW TO FILE YOUR CLAIM

1. Get a prescription and letter from your doctor for “Cranial Hair Prosthesis:

  1. Request your physician to write a letter explaining hair loss and it’s emotional effects. Cranial prosthesis is not simply for cosmetic reasons, it’s for emotional well-being.
  2. Be sure your doctor states specific diagnosis codes. For example, Alopecia alone is not a diagnosis.  Alopecia Totalis, Alopecia Areata, Alopeicia Universalis, etc. are valid diagnosis conditions.
  3. Use the Healthcare Common Procedure Coding Systems (HCPCS) codes: S8095 and A9282.
  4. Make sure your doctor states why this Cranial Prosthesis is considered DME (Durable Medical Equipment)

 

 2. Complete the necessary forms for your insurance company

  • Use the Healthcare Common Procedure Coding Systems (HCPCS) codes: S8095 and A9282.
  • Insurance companies also ask for a NPI Code - this code comes from a doctor. To find the code for your doctor, use the following link to the national database: NPI Registry Search.  Search for your provider using the Individual Provider search area.  The NPI number is a 10 digit number located under NPI information.
  • Have your physician sign off on your insurance claim form.

 

3. Submit the custom invoice we give you.

The invoice will specifically state “cranial hair prosthesis” and not a wig. Model Lace Wigs and Hair will provide this invoice for you. We’ll make sure it doesn’s say “wig” anywhere on the invoice, that it includes the necessary HCPCS insurance codes, and includes our Tax ID # which is required.

 

4. Hand-write an emotional letter explaining your situation

  • Detail the effects that your condition has had on your personal life and the necessity for the Cranial Hair Prosthesis in your life. (i.e. self-esteem, grief/depression, anxiety, daily activities, relationships.)
  • Take pictures of yourself without hair and without makeup.

 

5. Enclose these additional items to reinforce your claim:

  • Include photos of yourself without hair or a wig and without makeup. Show the wig is not for cosmetic purposes.
  • Include a letter from your employer explaining the importance of having hair
  • If you’re not comfortable asking your employer ask a close friend, relative, or spouse. 

DENIED? FILE AN APPEAL

  1. Double check your benefits and coverage to make sure “Cranial Hair Prosthesis” is covered in your policy. See if your insurance company calls it something else and learn how “wigs” are excluded from coverage.       
  2. Ask for a review by a medical review board, include the original claim.
  3. Ask for a written reply as to why the claim was denied.
  4. Send a letter tot he claims department supervisor.

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. Keep copies of all documentation, and please let us know if you have any questions. We are happy to help.

 

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:

National Alopecia Areata Foundation
14 Mitchell Blvd. San Rafael, CA 94903
E-mail: info@naaf.org
Web site: http://www.naaf.org/