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Tuesday, February 18, 2014

Insurance Coverage for Wigs

Coping with a medical condition is one thing; losing part of your identity is another. Insurance companies have begun to recognize that losing hair can be just as trying and emotional as losing a limb, digit, eyelid, etc. If your wig is used mostly for medical reasons (i.e. scalp infections, alopecia, cancer treatment, trichotillomania, or other treatments related to a medical condition), chances are your insurance will foot all or some (60-100%) of the bill on your behalf.

If you are new to the process, follow these steps for maximizing your chances of obtaining insurance coverage. As with most insurance related things, you should start by realizing that this may be a bit time consuming, cumbersome, and your claim could even be denied. However, it is well worth the try! And even if it is denied, no doesn’t always mean no. We’ll also show you how to make an appeal towards the end.

1) 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 as a medical need.  Your hair is a part of your identity and is a vital part of your day-to-day being.  Your insurance company may see or hear the word “wig” and think of a costume item, not the piece that helps to complete your look and identity. Having a cranial prosthesis allows you to operate in a discreet manner despite any medical condition.
It can help to know the lingo and understand why it is referred to as a “cranial prosthesis”.

2) Stay Organized
Now that you’re aware that this could be quite the process, make sure that you stay organized. There will be multiple items that you will need to submit.
-  Get a folder or a notebook to house all of these important items. If anything gets “lost”, you will be prepared!
-  Have copies of all of your materials (listed below)
-  Anytime you chat with anyone from the insurance company, write down their name, the time, what you discussed, etc.
-  When you mail your items, send them via certified mail to ensure they are received

3) Get a copy of your insurance contract
Most people only have a summary of their benefits. Get your hands on a full copy of your insurance contract. This contract will highlight all of the specific details in sections. Thumb through it until you find the section in regards to “Prosthetic Coverage”.  Some companies have listed information about their coverage on cranial prosthesis. If they have not, it is very important to look closely at the “Exclusions”. If a cranial prosthesis is not specifically mentioned as being excluded, that could be your window of opportunity.

4) Be familiar with the common requirements
Be educated when it comes to the typical documents associated with this type of claim. This will not only save you time, but also stream line the process quite a bit. When you call, you can be proactive and mention that you are either aware that you need or already have the following:
-  A prescription from your physician for your “cranial prosthesis” that also notes your specific condition as closely as possible
-  A proof of purchase via a sales receipt, credit card statement, check, etc. If at all possible, it helps that it is noted on the sales receipt that it is a cranial prosthesis.
-  A copy of your diagnosis
-The store’s Vendor or Store Tax ID
--Insurance Procedure Code (Commonly S8095 or Healthcare Common Procedure Code A9282)

5) Call your Insurance Provider and go over the requirements for your claim
Pretty simple! The reason it is not listed first is because it can save you and the person on the line a lot of time if you know most of what you need and are familiar with their process.

6) Wait and Follow Up
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!

If your claim is denied, you should file an appeal.

To do so:
1)   Address the letter to a specific manager in the Claims Department. You can obtain this information by calling the insurance company.
2)   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.
3)   Attach a photo of yourself with and without hair
4)   Provide a copy of your original claims (you should have copies in your folder!)
5)   Include a letter from your employer, doctor, or friend that supports your need

Illustrate what it is like to lose your hair. This is your opportunity to appeal to the human, emotional side of the insurance company.

      If you have lost your hair due to a medical condition, we highly recommend that you attempt to get your cranial prosthesis covered by your insurance company.  You pay for the service of insurance which assists you when you have a medical need such as this one. It does involve a little bit of work and process, but if you were to be reimbursed, you could always use a small part of the money to squeeze in a massage day (which you probably really deserve!). Good luck!

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