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Tuesday, February 18, 2014

The Ultimate Guide: Get Insurance to Cover Your Wig

Will My Insurance Cover A Wig? 

The short answer is yes! You just have to know what to say, how to say it, and put in a little elbow grease. Keep reading and we'll share all the goods.

Get on the same page as the insurance company: Wig vs. Cranial Prosthesis

In order for a wig to be covered, it needs to be considered a medical need. Wigs are often viewed as costume attire, but let's be real, you need hair for your day-to-day operations. Otherwise, your insurance company will say no can do.

So to get this party started, you will now be referring to your wig as what it is in the medical world-- a cranial prosthesis

Keep Your Documents Organized

Don't let a little paperwork hold you back from wig wearing success. Keep a folder on hand for easy organization.

Some things that will be in your folder:

  • Your insurance contract (for reference)
  • A cover letter with emotional appeal. Why does this matter to you?
  • Photos of you with and without hair
  • A copy of your diagnosis
  • A prescription from your physician for your “cranial prosthesis” that also notes your specific condition as closely as possible
  • Proof of purchase if you have already purchased your wig
  • The store’s Vendor or Store Tax ID
    Insurance Procedure Code (Commonly S8095 or Healthcare Common Procedure Code A9282)
In addition, make notes anytime you speak with someone from the insurance company. If you send mail, make sure it's certified. Paper trails pave the path to beautiful hair.

First Things First: Get a Copy of Your Insurance Contract

The contract is not to be confused with a summation of benefits. The contract covers the nitty gritty details. This information can be easily accessed by logging into your account or contacting your provider directly.

Look through your contract until you find the section in regards to “Prosthetic Coverage”, this is where you will find out whether they cover cranial prosthetics. 

If they haven't specifically addressed this topic in this section, continue reading until you locate another section called "Exclusions"

If a cranial prosthesis is not specifically mentioned as being excluded in the contract, then consider this an open window and climb on in. 

Make Your Case

Write a cover letter to submit with your documents. Appeal to the human behind the keyboard. Why is this important to you? What did you look like with hair and without hair? Include photos. Drive home the message about how much value this would bring to your life and well-being.

Not only does hair make you look and feel yourself, it helps you to blend in without having to explain your condition to outsiders. It can be a constant reminder. 

So, whatever your reason for needing or wanting a wig, use the proper terminology that speaks to the insurance providers as the humans that they are. 

Submit Your Claim, Wait, Follow Up

Before submitting your claim, it's a good idea to call your insurance company and make sure you have all of the required documents. 

Once you have everything you need, put it together and submit your claim. Send it via certified mail to ensure it's arrival.

As with most insurance claims, it can take some time to be processed. However, feel free to call and follow up as much as you like. It can never hurt!

What if My Claim For A Wig is Denied?

No worries. It isn't an indefinite no. You still have options.

File An Appeal:

Address the letter to a specific manager in the Claims Department. You can obtain this information by calling the insurance company.

Write a letter asking for a review by the Medical Review Board. 

Go into detail about the difference between a cranial prosthesis and a “fashion wig”. Also, feel free to include emotional details about your experience and why you feel that this is medically necessary.

Provide a copy of your original claims.

Include a letter from your employer, doctor, or friend that supports your need.

Questions? We're Happy To Help!

At Lynne's Wig Boutique, it's our goal to hold your hand through the wig buying process. It can be emotional and overwhelming. Let us help you pick out the perfect wig today. Stop into our American Fork location or visit our online store for a premier wig-shopping experience.

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