Many people ask “will insurance cover wigs?” Although I do not file insurance for my clients I do provide them with steps to take to file for reimburcement. I have on occassion made calls with my clients to their insurance provider to try to “interpret” the insurance policy.
The one thing I do know is that most companies will NOT reimburce for “wigs”. Medicare will NOT reimburce for “wigs” or “cranial or hair prosthesis” according to the current laws. I am totally amazed (more like blown away) that the insurance companies still see this as a cosmetic luxury rather than a medical need. I suppose that the insurance companies would rather pay for counseling and medication to help us cope rather than deal with the actual reason for our pain. However, my comments are coming from a layperson and not a professional in the insurance industry. Yet it would seem to me that if you deal with the source of the pain and provide hope and solutions the recovery time might be shorter and the expense less to the insurance providers, but again that is only the opinion of one.
I honestly believe insurance companies want to make hair reimbursement as difficult as possible. That may sound very callous and my desire is not to beat up on the insurance industry nor to come across as sarcastic. However, I deal with them a lot and hope the information below will help you file your claim and get any reimbursement your policy allows you to have. I have yet to see any insurance company approve the claim for a “cranial prosthesis” on the first submission, so prepare to be determined.
Here are the steps I have found to be most useful:
1. Your Dr must write you a prescription for either a “hair prosthesis” or a “cranial prosthesis” and state the reason for the need such as alopecia areata, alopecia totalis, or alopecia universalis, etc.
2. Ask your Dr to write a letter on their letter head to the insurance company stating your need for a cranial prosthesis due to a medical condition which could most likely to be a permanent part of your life. Should you be reading this and have hair loss due to cancer treatments ask your doctor to state that as your reason and that you will need hair for approximately 2 years due to the treatment. Some insurance companies require both the letter and the prescription, some require only one of them.
3. Call your insurance company and ask for someone who could help you concerning Durable Medical Equipment (DME) and what your policy specifically states concerning prosthesis. Once you have an expert on the phone from your insurance company and durable medical equipment ask them if they have any suggestions concerning submitting a claim for a cranial/hair prosthesis. Be prepared for them not to understand your question. Explain to them what you have and that you have a prescription from your Doctor for a prosthesis because your hair loss is not something you chose, but something you want to live with in dignity and respect. Stress to them this is not a wig for cosmetic purposes, but a medical need. Once they understand ask them for their help. I call this “making a friend” in the insurance company. Ask them if there is a specific code they need on the claim form for a cranial prosthesis. Also ask them if they could send you a copy of their claim form. Be sure to get their name and extension number incase you need to call them back (trust me you will probably have to call them back). Ask them if they have any advice for you concerning anything you can do to get this filed and processed easily.
4. The salon or person selling you the prosthesis must supply you with a receipt or invoice. The invoice must show exactly what you purchased and must use the terminology of either hair prosthesis or cranial prosthesis. It must also show you have paid in full either by credit card or by a check. If you paid by a check the check number must be on there. The owner of the salon must sign the receipt/invoice and state paid in full as well.
5. Keep copies of everything you submit to your insurance company, incase it gets lost or misplaced.
6. Send this information to the insurance company to the attention of the person you have been speaking with. Be sure you ask the person if it is OK for you to do this simply to try and speed up the process.
7. Be prepared for the claim to be denied.
8. Be prepared to call your contact concerning the denial and ask what more you can do.
9. If you are denied ask for a specific reason and ask them where in your policy that it states specifically that a cranial prosthesis is not covered. If they can not provide you with this information then you need to ask them to send you a copy of your policy if you don’t have a copy.
10. Some insurance companies do not cover cranial prosthesis at all, and it is stated specifically in their policy. NO companies cover “wigs”. Medicare will not cover wigs or cranial or hair prosthesis. I have seen some insurance companies who cover 1 cranial/hair prosthesis in a life time. I have seen some that will cover 2 a year. However, any of them that cover the prosthesis will usually deny the claim at least once. I have seen claims denied 4 and 5 times taking a full year to receive reimbursement.
11. Stay strong and see this as a journey. Know it can be frustrating. Don’t give up until you are either given a specific provable reason for the denial or you are reimbursed.
I would love to hear from you and hear your experiences. Let me know if these suggestions have helped you. Let me know if you get reimbursed.
Hairs to you