Is the hair covered under insurance?
Medical Insurance Claims
About Insurance coverage for Hair Prosthesis:
Did You Know that If a person requires a “Hair Prosthesis” while undergoing alopecia or cancer-related therapy may be eligible for reimbursement under their health insurance plan? Insurance Companies are realizing more and more that a Hair Prosthesis is a necessity for those recovering from alopecia and cancer treatments.
If you need to wear a wig because of medical reasons like alopecia or cancer-related therapy then the “wig” should be called a “Hair Prosthesis” particularly for insurance purposes. If you file an insurance claim for reimbursement for a “wig” instead of a “Hair Prosthesis” you will very likely be turned down. Most insurance companies cover between 80% to 100% of a Hair Prosthesis.
Guidelines for Filing Initial Insurance Claims:
1. Most insurance policies cover “Hair Prosthesis” but do not cover wigs.
2. Insurance companies cover the cost under CPT procedure codes S8095 and A9282
3. Get a letter and/or prescription from your doctor.
4. Make sure that the letter or prescription is for “Hair Prosthesis”
5. It should not say wig-if it does, have it redone, otherwise your claim will most likely be refused.
6. Have a receipt from the company you purchased the Hair Prosthesis. Make sure it says “Hair Prosthesis.”
7. Have the physician sign off on the insurance claim form.
Waiting for your claim to be processed – prepare yourself for having your claim denied:
1. Know your rights as the insured party.
2. Obtain a copy of your FULL contract with your carrier (most people only have a “Summary of Benefits” provided by the employer).
3. Read and know your contract. A . Pay attention to the “exclusions” Wigs are excluded for cosmetics reasons. B. Pay special attention to Prosthesis coverage. Most policies do not spell out exclusions under Prosthesis, and this is how you are likely to have your claim accepted.
Submitting your appeal – (after denial of claim as not a covered benefit)
1. Write asking for a review by the Medical Review Board.
2. Attach copy of original claims.
3. In your letter, inform them of the difference between a wig and Prosthesis. (A wig is a fashion item and not a necessity. Prosthesis is a necessity comparable to plastic surgery for a burn victim).
4. Ask for a written reply. (Companies try to avoid putting anything in writing).
5. Address your letter to a supervisor in the Claim Department.
Some other optional suggestions are:
a. Include a letter from your employer,
b. Take pictures of yourself without hair,
c. Hand write a letter detailing the emotional effects that your condition has had on your life