How to file a medical insurance claim for your wig

If you are in need of a wig or hair topper for medical reasons (Cancer related or Alopecia) you may be eligible for a reimbursement from your current health insurance provider?  

The trick is knowing what insurance companies look for.  A claim submitted with the term "wig" will more than likely be rejected by insurance companies because it is seen as a cosmetic expense, while referring to the same product as a "Cranial Hair Prosthesis" necessary for medically related hair loss will just as often result in a paid claim as a medical necessity.  Along with submitting a written prescription from a medical professional, it is important to send a personal note detailing the psychological effect the hair loss has had on you.

1. Receive a letter or prescription from your doctor for a “Cranial Hair Prosthesis.”  A prescription should include a diagnosis code, we will use this code when generating an invoice for submission to insurance.
2. Use the Healthcare Common Procedure Coding Systems (HCPCS) codes: S8095 and A9282.
3. Insurance companies also ask for an NPI Code - this code comes from a doctor.  Have a receipt from the company where you purchased your Cranial Hair Prosthesis. 
4. Also have the company where the piece was purchased include their Tax ID# on any receipts.
5. Have your physician sign off on the insurance claim form.
6. Double check your insurance claim form to make sure you legibly included the following elements:

• The item “Cranial Hair Prosthesis”
• Diagnosis Code
• NPI Code
• The billing HCPCS codes: S8095 and A9282
• The company’s Tax ID #
• Your physician’s signature

1. Know your rights and be informed. Obtain a copy of your full contract with your insurance company, a complete copy of your insurance policy can often be found online through your providers website.
2. Carefully read and understand the exclusions (“wigs”) and covered items (“Cranial Hair Prosthesis”) in your policy. See if your insurance policy calls it something other than “prosthesis.”
3. Write a letter to the Medical Review Board asking for a review. Be sure to attach a copy of original claims.
4. Emphasize that a wig is a cosmetic item and unnecessary. Prosthesis however, is necessary (comparable to plastic surgery for a burn victim).
5. Address your letter to a supervisor in the Claim Department and ask for a written reply.

Due to the differences in every individual's insurance policy, this may not work for everyone. This guideline is just for you to reference and to show you how to research if your insurance company covers "Cranial Hair Prosthesis" or something similar. Make sure you review and understand the procedures outlined by your insurance policy as they may differ between carriers.  Keep copies of all documentation including the receipt/invoice for your Cranial Hair Prosthesis (may even be a  tax deductible medical expense).

County Department of Social Services

• Depending on your County, sometimes they offer assistance for individuals who qualify and meet certain income guidelines

American Cancer Society

• Apply for a Grant or Voucher up to $75 to cover your Cranial Hair Prosthesis (must apply before purchasing a wig)
• Apply for an allotment to cover the rest of the cost if your insurance company only covers a partial amount
• Financial Assistance for a Wig Purchase: 1-800-227-2345

National Alopecia Areata Foundation (NAAF)

• Pre-purchase program provides financial assistance to those who qualify