Are you experiencing medical hair loss? You may be able to use your medical insurance policy to reimburse your hair topper purchase if you are undergoing hair treatment, or have thinning hair or a receding hair line.
Depending on your policy, most insurance companies will cover between 80-100% of a cranial prosthesis if you are wearing a wig for medical reasons and/or are experiencing medical hair loss.
Keep reading and follow the steps below to learn how you may be eligible for reimbursement on your hair topper purchase by going through your insurance company.
Does Health Insurance Cover the Cost of My Wig?
Yes! You may qualify if you are experiencing hair loss, whether temporarily or permanently, due to chemotherapy, alopecia or other medical conditions. You can file an insurance claim for full or partial cost of your cranial prosthesis. Double check your insurance benefits and coverage to ensure "Cranial Hair Prosthesis" is covered before you file your claim.
What is a Cranial Prothesisis?
A cranial prosthesis is custom hair that is specifically designed for individuals who have lost their hair due to medical conditions. A wig or topper is considered cosmetic, whereas a cranial hair prosthesis is directly related to medical hair loss. It's important to note the official terminology when filing your claim.
Types of Hair Loss Covered by Insurance
Chemotherapy Related Hair Loss
Kidney Related Hair Loss
Hair Loss Caused by Cancer
Alopeacia Areata Totalis a
Alopecia Areata Universalis
Radiation Related Hair Loss
Hair Loss Due to Thyroid Problems
Postpartum Hair Loss
Medical Hair Loss Due to Genetics, Stress, Reaction to Medical Illness, Life and Environmental Changes, Aging, Thinning, and/or Balding
THE STEPS TO FILE YOUR CLAIM
Step 1: Inquire with your insurance
You'll want to contact your insurance network to determine what types of benefits you have for a Cranial Hair Prosthesis. Remember to use proper terminology when contacting your insurance company! You'll want to ask them the following questions:
Do you cover a cranial prosthesis?
How much of the cost will my plan cover?
What terminology is needed on the prescription?
What insurance Healthcare Common Procedure Coding Systems (HCPSC) code is needed on the sales receipt? Common Codes are: S8095 and A9282
Step 2: Obtain a Prescription
If you are experiencing any form of medical hair loss, make an appointment to consult with your doctor. You'll need to receive a diagnosis from your doctor for a medical condition that causes medical hair loss with a prescription for a cranial prosthesis. Your diagnosis should include specific diagnosis codes, as well as the HCPCS codes and the reason why the Cranial Prosthesis is considered Durable Medical Equipment (DME).
When you go to purchase your hair topper, it's important that your invoice lists the topper as a cranial prosthesis with the proper medical code and Tax ID# of the company you purchased from.
When purchasing a bestie with Just Be. Hair, please communicate with us at the beginning of the purchasing process that you will be submitting your purchase to your insurance company for reimbursement. We will provide you with a customized invoice for submitting your claim that includes the necessary HCPCS insurance codes and our Tax ID#.
Step 3: Submit Your Insurance claim
Many medical insurance plans will partially or fully cover up to one medical wig a year, even if it's not listed on your policy of benefits. It's important to call your provider for pre-approval before purchasing so you are clear on the coverage.
Here is what you will need to file your claim:
Your Doctors Prescription
Sales Receipt for Cranial Prosthesis with HCPCS billing code & Company Tax ID
Completed Insurance Claim
A DME claim, if required by your insurance
Ways to Strengthen Your claim
There are a few extra steps you can take to strengthen your claim before submitting to your insurance company, such as:
Ask your physician to write a letter explaining hair loss & it's emotional effects
Have your physician include their NPI Code on the diagnosis
Ask your physician to sign off on your insurance claim form
Hand-write an emotional letter explaining your situation, detail the effects the condition has had on your personal life
Include photos of yourself without hair and makeup to show that the topper is not for cosmetic purposes
Include a letter from your employer or a close friend, relative, spouse explaining the importance of having hair
What to do if Your Claim is Denied
If your claim gets denied, you can do the following to appeal the decision:
Double check your benefits and coverage. See if your insurance uses a different term for Cranial Hair Prosthesis
Ask for a review by a medical review board
Ask for a written reply as to why the claim was denied
Send a letter to the claims department supervisor
Grants & Vouchers
You can apply for a grant or voucher up to $75 to cover your Cranial Hair Prosthesis (must apply before purchasing). Keep in mind, you must meet certain financial guidelines and apply for this voucher before you purchase a hair system. They will not issue vouchers retroactively for purchases. Visit the American Cancer Society to learn more.
The national Alopecia Areata Foundation has established the Ascot fund, which is a special pre-purchase program that provides financial assistance for those who have been diagnosed with alopecia areata. To find out if you qualify, visit the NAAF Website.