What’s Covered by Insurance – Important Information You Need to Know
If you need a wig as the result of a medical hair loss condition, such as alopecia or chemotherapy, the cost of your wig may be covered, partially or completely, by your health insurance. Many insurance companies cover between 80% and 100% of the cost of a wig. To ensure that you qualify for coverage, you must follow these steps:
Contact Your Insurance Provider to Ensure Coverage
Ask them if they will cover the cost of a “cranial prosthesis” (this is the term insurance companies use for wigs) required due to medical hair loss. Your provider will determine if you are eligible under prescription code S8095 (the prescription code which your physician will assign to your case). Find out how much they will cover, what types of documentation they require, and exactly what steps you should take in order to apply for coverage. NOTE: It is important that you refer to the wig as a “cranial prosthesis” or coverage will likely be denied.
Massachusetts, Connecticut, Oklahoma, New Hampshire, Minnesota, and Maryland all currently have legislation mandating that wigs (required for medical reasons) be covered by health insurance.
If you do not have health insurance, the county department of social services in most states offers assistance to individuals who meet certain income requirements.
If Your Provider Will Cover the Cost of a Wig…
You must follow their instructions precisely. You may need to ask your doctor to write a prescription or a letter that includes the reasons why you need a wig, noting that it is not for cosmetic purposes, but rather for your emotional well-being. Again, it is important that your doctor prescribe a “cranial prostheses”, not a wig, as insurance companies are very particular about this terminology. Other helpful suggestions are taking pictures of yourself without hair, and writing a letter describing the emotional effects hair loss has had on your life.
Some providers allow you to bill them directly, though most will ask that you pay up front, and then submit proof of payment (i.e. a receipt or invoice) for reimbursement. When you purchase your wig, be sure to obtain an invoice/sales receipt stating that you’ve purchased a “cranial prosthesis” (again, do not use the term “wig” or coverage may be denied). Keep copies of your invoice/receipt, as portions not covered by insurance may be tax-deductible.
If Your Provider Will Not Cover the Cost of a Wig…
You still have options. Here are some of the steps you can take:
- Ask for a written reply stating why the claim was denied.
- Send a letter to your insurance provider, addressed to the attention of the Supervisor of the Claims Department.
- If you have alopecia areata and meet the required financial guidelines, you may be eligible for a grant which covers a percentage of or the full cost of the wig, through the National Alopecia Areata Foundation’s Ascot Fund. To find out more, contact NAAF at:
-
- National Alopecia Areata Foundation
- 14 Mitchell Blvd.
- San Rafael, CA 94903
- or
- PO Box 150760
- San Rafael, CA 94915-0760
- Phone: 415-472-3780
- Fax: 415-472-5343
- Email: infor@naaf.org
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- The American Cancer Society offers vouchers for up to $75 toward the cost of a wig for those who meet certain financial guidelines. You must apply for this voucher and must be approved before you can make your purchase. To find out more, contact ACS at:
- American Cancer Society
- Phone: 1-800-227-2345
- (ask to speak with someone regarding financial assistance for the purchase of a
“cranial prosthesis”)
- www.cancer.org
-
- Finally, you may also consult with your doctor. Many cancer centers are familiar with local organizations that provide recycled wigs, free or at a reduced cost.
Should you decide to purchase a wig from Paula Young, a representative will be happy to assist you with any questions you may have, as well as any paperwork that is required from them. Call a Customer Services representative toll-free at 1-800-364-9060 Monday-Friday, 7am-10pm or Saturday, 9am-6pm (EST) for assistance.
NOTE: Paula Young® does not process medical claims, nor do they accept prescriptions.