Medical Wig Insurance

How To Get Your Wig Covered by Medical Insurance

Did you know you can get your wig cost covered by your medical insurance? Well, it is not a myth but there are some conditions to meet. In this blog, we will discuss the conditions and walk you through the steps you need to take to get your medical wig insurance coverage.
You will learn more about cranial prostheses, insurance reimbursement for wigs, and what to do if your insurance does not accept to reimburse you.

What Is a Medical Wig or Cranial Prosthesis?

There are some illnesses and treatments that can lead to complete or partial hair loss. People who lose their hair because of cancer, alopecia (hair loss), diabetics, some coronary artery diseases, trichotillomania (a disorder when someone cannot stop pulling out or breaking their own hair), and other medical conditions, need to use medical wigs or hair pieces, also known as cranial hair prosthesis.

Medical wigs can be prescribed by a doctor for men, women, and kids. So, the purpose of medical wigs is not just to improve the appearance, but also to protect their sensitive scalp (especially after chemotherapy), and to help the patients maintain their regular activities.

How Medical Wigs Are Different?

As the patient’s skin can be sensitive, the medical wigs are be crafted a bit differently than the costume or fashion wigs. The best quality materials are used for the wigs’ caps to prevent any irritation and to last longer. Unlike a costume wig that can only be worn a few times, our wigs last months or years depending on what fiber type you choose. We have heat friendly synthetic, synthetic, human hair and remy human hair wigs. Below is a breakdown of the life spans of price points:

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Heat-Friendly Synthetic: 4-6 months, $150-$600

Synthetic: 6 months $150-$600

Human Hair/Synthetic Blend: 6-12 months, $550-$2,800

Human Hair and Remy Human Human: 1-3 years. $900-$5,000

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Life span = If worn daily and cared for properly. 

Price point= Varies by length and cap construction.

What Is a Medical Wig Insurance?

If you are in need of a wig due to medical hair loss, then your medical insurance company is probably offering you cranial hair prosthesis coverage. This means that your insurance covers your wig’s cost partially or fully. Most insurances will cover 80%-100% of the cost of your wig. However, there are measures you need to take to claim that. Read on to learn about all the steps you will need to take and related information about insurance companies and cranial prostheses.

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What to Do to Get Your Medical Wig Insurance Coverage?

Buying a quality medical wig can be expensive. So, pursuing insurance coverage, despite its troubles, is worth it. To do so, you will need to go through the following steps before purchasing your wig. Make sure that you start the process as soon as possible, as it may take a while.

Step 1:

Contact your insurance representative and ask them about their cranial prosthesis coverage (if any). You should know how much of the cost they are ready to cover, how they are going to pay it, what type of hair loss they cover, what documentation is needed to file your claim, and what terminology your physician must use on your prescription.
When contacting an insurance company, try not to use the word ‘wig’. It is important to use the right terms, such as ‘cranial hair prosthesis’ or ‘cranial prosthesis’.

Step 2:

Get the right prescription from your doctor. Ask him/her to

• include the terms that your insurance requested.

• state your condition specifically. For instance, just the word ‘cancer’ is not suitable, adding the type is necessary.

• include the medical procedure number or code (Healthcare Common Procedure Coding System, HCPCS), such as A9282, and S8095.

• Explain why your cranial prosthesis is a piece of durable medical equipment (DME).

• write a letter and explains why you are in need of a cranial prosthesis (the reason for your hair loss) and how it can improve your conditions (mentally, emotionally, and physically). This might be optional but can make a big difference.

• use the right terminology, and never use the word ‘wig’ or anything else that would associate your case with cosmetics.

• Sign the form(s) you completed to submit your claim.

Step 3:

Prepare all the documents required to submit. They include:

• The insurance claim form(s). You can also get the NPI Code required by the form by contacting us directly.

• Your prescription.

• Your doctor’s letter.

• Your cranial prosthesis’ invoice (If you need to pay upfront and then be reimbursed by the insurance provider.). It needs to include the medical procedure code as well as our shop’s Tax ID Number. The word ‘wig’ should not be used to describe the product you purchased.

Before sending the documents, make a copy of each one and keep them. You may also want to write a letter of your own and explain your situation and even attach a picture of yourself to provide more evidence for your medical condition. It is also possible to ask a friend or a family member to write a letter for you to support your claim.

(Step 4):

In case your claim is denied, an appeal can be filed. A medical board will review your case again. You should also ask your insurance provider for the reason for the denial. If there is any problem with the documentation, try to amend it.
Except for insurance, there are other options to get financial assistance, which will be discussed shortly.

How Your Insurance Pays for Your Cranial Prosthesis

Depending on the company’s policy, the way they pay for the medical wig is different. There are two ways to cover it:

• Reimbursement: This means you pay for the wig yourself and then the insurance will reimburse (repay) you fully or partially, according to your insurance plan.

• Upfront payment: This means the insurance pays for your hair prosthesis upfront (in advance) and you will not need to pay it yourself.

Medical Hair Losses Covered by Medical Health Insurance

Again, it depends on the company and your insurance plans but the following hair losses are most likely covered.

• Most types of alopecia (including Areata, Areata Totalis, and Areata Universalis)

• Anemia (Mostly Trickle-Cell)

• Hair loss due to childbirth (postpartum)

• Hair loss due to cancer and/or chemotherapy

• Hair loss due to radiation

• Hair loss due to severe hypothyroidism or hyperthyroidism

• Hair loss due to severe chronic kidney disease

• Other common medical causes (such as genetics and mental health disorders)

What to Do If Your Insurance Does Not Cover Cranial Prosthesis?

Even if your claim is denied or your insurance provider does not cover medical wigs, there are other paths you can take to get help with the expenses, such as a grant or a voucher. In most cases, it is required to apply for this type of grant or voucher.

If you meet the conditions, you will be offered a certain amount of money as financial assistance. For instance, Hats For Hope, the American Cancer Society, and National Alopecia Areata Foundation (NAAF) are three organizations that offer various programs to assist cancer and/or alopecia patients.
Hats For Hope offers a $200 Gift Certificate to be used at our salon, the American Cancer Society is willing to grant up to $75 for a medical wig for the benefit of cancer patients, and NAAF’s Ascot Fund is also there for alopecia Areata patients with financial assistance that can go as high as $500, provided that the patient is evidentially incapable of purchasing a suitable hair piece.
Aside from the grants, you may be qualified for a tax deduction. It is wise to keep all the receipts you pay during the process of getting a hair piece.

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Tres Joli Wig Salon

Our salon provides a wide variety of wigs and hair pieces in an effort to meet everyone’s budget and needs. You can reach out to an alternative hair specialist in Grover Beach at 805-904-6808 and have a free consultation with us.

For your medical wig insurance coverage, we are ready to do anything we can to help you out. If you order a cranial hair prosthesis from us, our experienced staff will help you by providing you with a cranial hair prosthesis receipt for the hair piece that is required by the insurance companies. We are here for you.