Medical Wig Insurance: How to Get a Free Wig
Did you know you can get your wig cost covered by your medical insurance? Well, it is not a myth but there are some conditions to meet. In this blog, we will discuss the conditions and walk you through the steps you need to take to get your medical wig insurance coverage.
You will learn more about cranial prostheses, insurance reimbursement for wigs, insurance companies that offer the coverage, and what to do if your insurance does not accept to reimburse you.
What Is a Medical Wig or Cranial Prosthesis?
There are some illnesses and treatments that can lead to complete or partial hair loss. People who lose their hair because of cancer, alopecia (hair loss), diabetics, some coronary artery diseases, trichotillomania (a mental disorder when someone cannot stop pulling out or breaking their own hair), and other medical conditions, need to use medical wigs, also known as cranial hair prosthesis.
Some types of cranial prostheses include cancer wigs, alopecia wigs, thyroid wigs, trichotillomania wigs, etc. You can click on each one to see the service we offer for that type of wig.
Medical wigs can be prescribed by a doctor for men, women, and kids. So, the purpose of medical wigs is not just to improve the appearance, but also to protect their sensitive scalp (especially after chemotherapy), and to help the patients maintain their regular activities.
How Medical Wigs Are Different?
As the patient’s skin can be sensitive, the medical wigs should be crafted a bit differently than the fashion wigs. The best quality materials are used for medical wigs’ caps to prevent any irritation. The hair used in all hair prostheses is usually 100% natural, and the wig is custom designed for the patient. They are normally easier to wear and maintain.
For more information on the difference between fashion wigs and medical wigs click here.
What Is a Medical Wig Insurance?
If your wig is prescribed due to medical hair loss, then your medical insurance company is probably offering you cranial hair prosthesis coverage. This means that your insurance covers your wig’s cost partially or fully. However, there are measures you need to take to claim that.
Read on to learn about all the steps you will need to take and related information about insurance companies and cranial prostheses.
What to Do to Get Your Medical Wig Insurance Coverage?
Buying a quality medical wig can cost you thousands of dollars. So, pursuing insurance coverage, despite its troubles, is worth it. To do so, you will need to go through the following steps before purchasing your wig. Make sure that you start the process as soon as possible, as it may take a while.
Contact your insurance representative, and ask them about their cranial prosthesis coverage (if any). You should know how much of the cost they are ready to cover, how they are going to pay it, what type of hair loss they cover, what documentation is needed to file your claim, and what terminology your physician must use on your prescription.
When contacting an insurance company, try not to use the word ‘wig’. It is important to use the right terms, such as ‘cranial hair prosthesis’ or ‘cranial prosthesis’.
Get the right prescription from your doctor. Ask him/her to
- include the terms that your insurance requested.
- state your condition specifically. For instance, just the word ‘cancer’ is not suitable, adding the type is necessary.
- include the medical procedure number or code (Healthcare Common Procedure Coding System, HCPCS), such as A9282, and S8095.
- Explain why your cranial prosthesis is a piece of durable medical equipment (DME).
- write a letter and explains why you are in need of a cranial prosthesis (the reason for your hair loss) and how it can improve your conditions (mentally, emotionally, and physically). This might be optional but can make a big difference.
- use the right terminology, and never use the word ‘wig’ or anything else that would associate your case with cosmetics.
- Sign the form(s) you completed to submit your claim.
Prepare all the documents required to submit. They include:
- The insurance claim form(s). If you are confused with the form, contact us at 949-322-9555 for a free consultation. You can also get the NPI Code required by the form from this NPI Records search.
- Your prescription
- Your doctor’s letter
- Your cranial prosthesis’ invoice (If you need to pay upfront and then be reimbursed by the insurance provider.). It needs to include the medical procedure code as well as the wigs shop’s Tax ID Number. The word ‘wig’ should not be used to describe the product you purchased.
Before sending the documents, make a copy of each one and keep them. You may also want to write a letter of your own and explain your situation and even attach a picture of yourself to provide more evidence for your medical condition. It is also possible to ask a friend or a family member to write a letter for you to support your claim.
In case your claim is denied, an appeal can be filed. A medical board will review your case again. You should also ask your insurance provider for the reason for the denial. If there is any problem with the documentation, try to amend it.
Except for insurance, there are other options to get financial assistance, which will be discussed shortly.
Does Your Insurance Provider Cover the Medical Wig’s Cost?
Whether the insurance company accepts to reimburse you, how much of the cost they are ready to cover, and how they pay you depends on your insurance plan.
Two main factors decide if your wig’s cost is covered.
- If the company’s plan includes cranial prosthesis coverage or not: Most insurance companies have this policy but the amount they are ready to cover can vary. Others consider all types of wigs cosmetic and do not cover them at all.
- If you are qualified to get a cranial prosthesis: You need to meet some conditions and prove that your wig is actually a medical one.
Insurance Companies and Their Medical Wigs Policies
Here, some of the most famous insurance companies and their policies toward cranial hair prostheses are introduced.
Those that cover it:
Please note that the following details depend on your insurance plan. Contact your insurance representative to make sure your plan covers cranial prostheses before you purchase one.
- Blue Cross Blue Shield (only leukemia and cancer wigs, once in your lifetime, 100% coverage but up to $350 according to their 2021 standards)
- CIGNA Emerald Health Network (100% coverage)
- Equitable Life Aetna ($1000 reimbursement, only for diagnosis code A9282, 80% coverage)
- Metropolitan Life (80% coverage)
- Tricare (only for diagnosis code A9282)
- Metropolitan Educator of New York (80 to 100% coverage)
- Med Choice Provident Mutual (80% coverage)
- Prudential Life Insurance (80 to 100% coverage)
- Midwest Benefits Corp (no further information)
- John Hancock Insurance Company (no further information)
- United Healthcare (no further information)
- Humana (no further information)
Those that do not cover it:
Although, as far as we know, the following companies do not cover cranial prosthesis under group nor individual policy plans, we do recommend you contact the agent and make an inquiry if you are a client.
- Baylor Scott & White
How Your Insurance Pays for Your Cranial Prosthesis
Depending on the company’s policy, the way they pay for the medical wig is different. There are two ways to cover it:
- Reimbursement: This means you pay for the wig yourself and then the insurance will reimburse (repay) you fully or partially, according to your insurance plan.
- Upfront payment: This means the insurance pays for your hair prosthesis upfront (in advance) and you will not need to pay it yourself.
Medical Hair Losses Covered by Medical Health Insurance
Again, it depends on the company and your insurance plans but the following hair losses are most likely covered.
- Most types of alopecia (including Areata, Areata Totalis, and Areata Universalis)
- Anemia (Mostly Trickle-Cell)
- Hair loss due to childbirth (postpartum)
- Hair loss due to cancer and/or chemotherapy
- Hair loss due to radiation
- Hair loss due to severe hypothyroidism or hyperthyroidism
- Hair loss due to severe chronic kidney disease
- Other common medical causes (such as genetics and mental health disorders)
What to Do If Your Insurance Does Not Cover Cranial Prosthesis?
Even if your claim is denied or your insurance provider does not cover medical wigs, there are other paths you can take to get help with the expenses, such as a grant or a voucher. In most cases, it is required to apply for this type of grant or voucher before purchasing your hair prosthesis.
If you meet the conditions, you will be offered a certain amount of money as financial assistance. For instance, the American Cancer Society and National Alopecia Areata Foundation (NAAF) are two organizations that offer various programs to assist cancer and alopecia patients.
American Cancer Society is willing to grant up to $75 for a medical wig for the benefit of cancer patients. It is even possible to find a donated wig on their website. NAAF’s Ascot Fund is also there for alopecia Areata patients with financial assistance that can go as high as $500, provided that the patient is evidentially incapable of purchasing a suitable hairpiece.
Aside from the grants, you may be qualified for a tax deduction. It is wise to keep all the receipts you pay during the process of getting a hairpiece.
How Newport Hair Loss Center Can Help
Our hair loss center provides the best quality human hair cranial prostheses which are designed meticulously for the utmost comfort of patients. The custom hair systems are also uniquely crafted for each patient to match their needs, conditions, lifestyle, and skin. You can reach out to our cranial prosthesis specialists at our branches in Los Angelos (310-991-0087), Orange County (949-322-9555), and Sandiego (949-640-4247), and have a free consultation with us.
For your medical wig insurance coverage, we are ready to do anything we can to help you out. If you order a cranial hair prosthesis from Newport Hair Loss Center, our experienced staff will help you with your claim forms and provide you with a standard receipt for the hair piece that is acceptable by the insurance companies. We are here for you.