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medical-insurance-wigs

How to file a medical insurance
claim for your wig or hairpiece

Did you know, that if you are like so many of the men and women out there that need a wig for a medical reason (Cancer related wig or Alopecia wig) you may be eligible for a reimbursement from your current health insurance provider?  In fact, most insurance companies will cover between 80% and 100% of the purchase price of a wig or hairpiece for medically related hair replacement purposes.

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.

How to File Your Initial Insurance Claim

  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 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.
  4. Have a receipt from the company where you purchased your Cranial Hair Prosthesis. Make sure it does not say “wig” anywhere and that it includes the HCPCS insurance codes.  *WE CAN HELP WITH THIS*
  5. Also have the company where the piece was purchased include their Tax ID# on any receipts.
  6. Have your physician sign off on the insurance claim form. Make sure your doctor states why this Cranial Prosthesis is considered DME (Durable Medical Equipment)
  7. Double check your insurance claim form to make sure you legiblyincluded 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


Appealing a Denied Insurance Claim

  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.
  6. Some other suggestions are:
  • Include pictures of yourself without hair and a letter detailing the emotional effects your hair loss has had on your life
  • Include a letter from your employer4
  • Understand which medical codes to use on your forms.  Different conditions may require different diagnosis codes. Check with your prescribing physician for the codes related to your condition.


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).

Helpful Resources


Contact The Wig Shop for additional information or to obtain your properly itemized receipt if you bought your piece from us. We are happy to help and can email you a pdf copy of your receipt.

 

  • Call us at (843) 651-4504


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

 


Older information (March 2024)

Did you know that many insurance companies will pay towards your synthetic or human hair wig or topper purchase? Most insurance companies cover between 80 to 100% of a cranial prosthesis. Depending on your policy, if you are wearing a wig for medical reasons and experiencing medical hair loss. Follow these steps to see how you may be eligible to be reimbursed on your next wig by going through your insurance.

Confirmed Insurance Companies Offering Cranial Prosthesis Benefits:

Inquiry: Call Your Insurance

Determine what types of benefits you have within your network for a “Cranial Hair Prosthesis” Terminology is very important during this inquiry, do not call the unit a wig. You may also refer to it as a “hair replacement unit” depending on your insurance.

Ask your insurance the following questions:

  1. “Do you cover a cranial prosthesis?”
  2. “How much of the cost will my plan cover?”
  3. “What terminology is needed on the prescription?”
  4. “What insurance HCPSC code is needed on the sales receipt?”

Diagnosis: Obtain A Prescription

Visit your doctor if you are experiencing any form of medical hair loss. Make sure to receive a diagnosis from your doctor for a medical condition that causes your medical hair loss. Make sure your doctor writes you a prescription for a cranial prosthesis. When the wig is purchased it is important for the invoice to list the wig as a cranial prosthesis with the proper medical code. The invoice should be submitted to the insurance company for reimbursement.

Most Types of Medical Hair Loss Covered By Insurance

  • Alopecia Areata
  • Alopecia Areata Totalis a
  • Alopecia Areata Universalis
  • Trickle-Cell Anemia
  • Postpartum Hair Loss
  • Chemotherapy Related Hair Loss
  • Radiation Related Hair Loss
  • Thyroid Related Hair Loss
  • Kidney Related Hair Loss
  • Cancer Related Hair Loss
  • Medical Hair Loss Due to Genetics, Stress, Reaction to Medical Illness, Life and Environmental Changes, Aging, Thinning, and/or Balding

File: Submit Your Insurance Claim

Many medical insurance plans will cover partially or in full for your next wig even if it is not listed on your policy of benefits. It is important to call your insurance provider for pre-approval before purchasing your next wig online so you will be clear on your coverage. Make sure you call a wig by the official medical term which is cranial prosthesis. The term “wig” is viewed as cosmetic, so it is very important to use the medical term when inquiring about coverage.

Documents You Need:

  1. Your doctor’s prescription
  2. The Wig Shop sales receipt for a Cranial Prosthesis with HCPCS billing code and Tax ID
  3. Completed insurance claim
  4. A DME claim if required by your insurance

Keep copies of your sales or invoices for your cranial prosthesis. Portions of unpaid items by insurance are tax deductible.

Advice: How To Buy The Perfect Medical Wig

The Wig Shop is a provider of medical wigs and is in the forefront of providing hair solutions for women experiencing all different forms of medical hair loss. Our innovative wig cap designs and secure method allow the perfect solutions. We offer a wide variety of customizable options for your wig’s cap, hair type, color, cut, and style. With our showroom options we are here for you through every step of your wig wearing journey. Regain your self confidence let us help you find the perfect wig for your lifestyle!

Denied?You can file an appeal with your insurance company and/or apply for a grant or voucher

American Cancer Society - You can apply for a Grant 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.

National Alopecia Areata Foundation (NAAF)This foundation offers the Ascot fund, which is a special pre-purchase program that provides financial assistance for individuals who have alopecia areata.