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

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.
  7. Double check your insurance claim form to make sure you legibly included 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 employer.
    • 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).

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