Billing Insurance For Wigs: A Comprehensive Guide For Medical Professionals

Many people experience hair loss due to medical conditions such as alopecia, chemotherapy, or other medical issues. If you are one of them, you may be able to get your wig covered by your medical insurance. This is known as a cranial prosthesis and is a custom hair system designed for patients with hair loss due to medical reasons.

The process to get your wig covered by insurance may be lengthy and varies depending on your insurance plan. Firstly, you should contact your insurance provider to ask about their cranial prosthesis coverage and what type of hair loss they cover. Secondly, get a prescription from your doctor for a cranial prosthesis, including the medical procedure code. It is important to note that the prescription should not use the word wig as this is considered a fashion item and is therefore not medically necessary. Finally, submit the claim to your insurance company for reimbursement.

Depending on your insurance plan, they may pay upfront for your wig or reimburse you after you have purchased it. It is also important to keep in mind that some insurance companies are specific about the cause of hair loss. For example, Blue Cross Blue Shield only covers prosthesis wigs if the hair loss is due to a burn or chemotherapy.

Understanding if your insurance plan covers wigs

Wig loss due to medical conditions can be covered by insurance, but it takes some work to find out if you're qualified and if your health insurance policy is among those that offer this option.

A cranial prosthesis is a wig for medical patients who have permanent hair loss (such as alopecia areata, alopecia totalis, trichotillomania), or temporary hair loss resulting from treatment for chemotherapy, radiation, or any other clinical disease. The term "cranial prosthesis" is used when applying for medical insurance or tax deduction status. Other common terms for a wig used for medical purposes include: full cranial prosthesis, hair prosthesis, cranial hair prosthesis, and extra-cranial prosthesis.

Your Coverage Depends on Your Insurance Plan

For medical hair loss, you may obtain payment for the full cranial prosthesis. Depending on your policy, some insurance companies will require you to pay upfront and then be reimbursed, while others will pay for your prosthesis upfront. Most insurance companies cover between 80-100% of the cost of your full cranial prosthesis and will allow you to receive one cranial prosthesis per year for medical hair loss.

Steps to Take

• Contact your Health Insurance Provider's Benefits Services and ask:
• If your policy covers a cranial prosthesis
• If yes, what type of cranial prosthesis is covered (i.e. synthetic wigs, human hair wigs, etc.)
• How much of the cost will they cover
• What specific terminology they need to have on the prescription for a wig
• What specific documentation they need to submit your claim

Note: If you are reviewing your insurance policy and do not see cranial prosthesis listed, this does not automatically mean that you don’t have coverage. We highly recommend calling your Health Insurance Provider and getting pre-authorization.

• Request and obtain a prescription for a "cranial prosthesis" (or the specific terminology required by your Health Insurance Provider) from your doctor or physician, including the medical procedure code A9282. Make sure the prescription does not say "wig." A wig is considered a fashion item and is therefore not medically necessary. Your prescription will include a procedure number/code for your cranial prosthesis that will be used to submit your insurance claim.
• Ask your physician to also write a letter explaining hair loss and its effects and stating that it is not simply for cosmetic reasons but for your emotional well-being.
• Keep copies of all your documentation and invoices from your physician for tax exemption purposes. You will need to consult your tax advisor first about medical bills and tax-deductible opportunities.
• If you are planning on paying upfront or out of pocket initially, place your order online or over the phone. Once you place your order, email sales with your order number and say that you need a copy of your invoice for your cranial prosthesis prescription. They will provide you with a copy of your invoice with a notation on the bottom that states Cranial Prosthesis and their Tax ID number.
• Send all documentation (your doctor’s prescription, copy of your invoice, completed insurance claim form, and any other necessary forms) to your Health Insurance Provider.

If Your Insurance Won't Help Cover the Cost of Your Wig

If your insurance won't cover the cost of your wig, you may still have options:

• When paying for your wig out of pocket, save the receipt just in case your purchase qualifies as a tax deduction. If a person's medical bills are over 7.5% of their income, then the wig would become tax-deductible.
• Talk with your doctor or social worker about local resources. Contact your local chapter of the American Cancer Society, National Alopecia Areata Foundation (NAAF), and other foundations about qualifying for financial assistance toward the purchase of a hairpiece or wig.

Knowing the terminology to use when applying

Knowing the right terminology to use when applying for a wig to be covered by your insurance is crucial. The first step is to contact your insurance representative and ask them about their cranial prosthesis coverage. It is important to not use the word 'wig' when corresponding with your insurance company. Instead, use the terms 'cranial hair prosthesis' or 'cranial prosthesis'.

The next step is to get the right prescription from your doctor. Ask them to include the terms that your insurance company requested, such as 'cranial prosthesis' or 'cranial hair prosthesis'. It is also important to include the specific type of cancer, if applicable, and not just the word 'cancer'. The prescription should also include the medical procedure number or code, such as A9282 or S8095.

Additionally, your doctor should explain why your cranial prosthesis is a piece of durable medical equipment (DME) and why you need it for your mental, emotional, and physical well-being. This letter should also refrain from using the word 'wig' or anything else that associates your case with cosmetics.

Finally, make sure to keep copies of all your invoices and documentation from your doctor for tax exemption purposes. It is also recommended to consult with your tax advisor regarding tax-deductible items and medical bills.

Getting a prescription and referral from your doctor

Firstly, it is important to understand the reason for needing a wig. Wigs can be prescribed for medical reasons, such as hair loss due to chemotherapy, alopecia, trichotillomania, or other clinical diseases. If you are experiencing hair loss due to any of these reasons, it is essential to consult your doctor to determine if a wig is a suitable solution for you.

Once you have discussed your needs with your doctor, you can request a prescription for a "cranial prosthesis". This term is crucial when dealing with medical insurance. Avoid using the word "wig" in your prescription, as it may be considered a fashion item rather than a medical necessity. Ensure that your prescription includes the medical procedure code A9282, as this will be necessary for submitting your insurance claim.

In addition to the prescription, ask your doctor to write a letter explaining your hair loss, its effects, and how a wig is not simply for cosmetic reasons but for your emotional well-being. This letter can support your insurance claim and highlight the medical necessity of the wig.

Keep in mind that the process may vary depending on your location and insurance provider. For example, in the UK, the National Health Service (NHS) offers wigs to patients experiencing hair loss due to cancer treatment. Your cancer nurse will typically refer you to a local NHS wig supplier, and you may receive a referral letter to make an appointment. The supplier will have a range of wigs covered by your NHS prescription, and you can choose the style that suits you best.

It is also important to note that you may need to pay a prescription charge or a contribution towards the cost of the wig, depending on your eligibility for financial support. If you are unsure about your coverage, it is recommended to consult your healthcare provider or insurance company directly to understand your specific plan's inclusions and exclusions.

Remember to keep copies of all documentation, including your doctor's prescription, letters, and invoices, as these will be necessary when submitting your insurance claim or applying for tax deductions related to medical expenses.

Submitting the required documentation to your insurance company

To submit the required documentation to your insurance company, you will need to take several steps. Firstly, contact your insurance provider and ask about their coverage, what type of hair loss they cover, what documentation is required, and what terminology your doctor must use on your prescription. It is important to use the correct terms, such as "cranial hair prosthesis" or "cranial prosthesis", and to avoid the word "wig", as wigs are often considered fashion items rather than medical necessities.

Next, obtain a prescription from your doctor using the correct terminology and including a procedure code, such as A9282. You may also ask your doctor to write a letter explaining the reasons for your hair loss and how a wig will improve your emotional well-being. This can add a personal touch to your claim and increase the chances of approval.

Once you have the prescription and any supporting documentation from your doctor, gather your invoices and receipts related to the wig purchase. If you paid out-of-pocket upfront, make sure to keep a copy of the receipt for tax purposes and reimbursement.

Finally, submit all the required documentation to your insurance company. This typically includes your doctor's prescription, completed insurance claim form, invoices, and any other necessary forms. Keeping a paper trail and maintaining copies of all paperwork is essential in case you need to resubmit your claim or for tax purposes.

If your insurance company denies your claim, don't lose hope. You can file an appeal, and there may be other options for financial assistance or grants to help cover the cost of your wig.

Paying upfront and claiming reimbursement

If your insurance company requires you to pay upfront and then be reimbursed, you will need to follow these steps:

Step 1: Contact your insurance provider

Before purchasing a wig, it is important to verify that your insurance plan covers cranial prostheses and wigs. Contact your insurance provider to ask about their coverage, how much they are willing to cover, and what type of hair loss they cover. It is important to use the correct terminology when speaking to your insurance provider, such as "cranial hair prosthesis" or "cranial prosthesis", and to avoid using the word "wig". Ask them what documentation is needed to file your claim and what terminology your physician must use on your prescription.

Step 2: Get a prescription from your doctor

Obtain a prescription for a "cranial prosthesis" from your doctor, using the correct terminology required by your insurance provider. Include the medical procedure code A9282 and, if applicable, S8095. It is important that the prescription does not use the word "wig" as it is considered a fashion item and is therefore not medically necessary. You can also ask your doctor to write a letter explaining the impact of hair loss and how the cranial prosthesis will improve your emotional well-being, rather than being for cosmetic reasons.

Step 3: Purchase the wig

Purchase the wig and keep the receipt and invoice. The invoice should include the medical procedure code and the wig shop's Tax ID Number. Again, avoid using the word "wig" on the invoice.

Step 4: Submit the documentation to your insurance provider

Submit all the necessary documentation to your insurance provider, including the doctor's prescription, completed insurance claim form, invoice, and any other required forms. Make copies of all the paperwork and keep them for your records.

Step 5: Follow up as needed

If your claim is denied, you can file an appeal to have your case reviewed again. Contact your insurance provider to understand the reason for the denial and make any necessary amendments to your documentation. If your insurance provider still does not cover the cost, you may be able to claim a tax deduction for the wig if your medical bills exceed 7.5% of your income.

Frequently asked questions