Medical Insurance Coverage

Medical Wig (Cranial Prosthesis) Insurance Coverage Guide

Did you know there is such a thing as medical wig or “Cranial Prosthesis” insurance? Yes! There are several steps needed to qualify & your health insurance needs to offer this option. Below is our guide to medical wig insurance claims.

Does Health Insurance Cover The Cost Of Your Medical Wig (Cranial Prosthesis)? 

Absolutely! If you are experiencing hair loss whether temporary or permanent your health care provider can write a prescription for a "cranial prosthesis". Unfortunately, not many people know this, but needing a wig due to hair loss caused by alopecia, chemotherapy, or other medical conditions, is covered by many insurances. Typically, medical insurances cover 80%-100% total costs.

What is a Cranial Prosthesis?

A cranial hair prosthesis is a custom hair system specifically designed for patients who have lost their hair due to medical conditions. These conditions include but are not limited to chemotherapy, alopecia totalis, alopecia areata, androgenetic alopecia, scarring alopecia, high blood pressure and other conditions resulting in hair loss.

It’s important to know the terminology when applying for medical insurance or tax deduction status. Other common terms used to describe a medical wig include: cranial hair prosthesis, hair prosthesis, and full cranial prosthesis.

Your Insurance Will Let You Know If You’re Covered

Whether or not your medical wig is covered by your insurance company depends on your plan. But it’s possible to receive full payment for your full cranial prosthesis. However, while some insurance companies will pay for your prosthesis upfront, others require you to pay upfront and then get reimbursed.

Many insurance companies cover 80-100% of the cost for your full cranial prosthesis. They also allow one cranial prosthesis per year for medical hair loss. Additionally, you may also be able to deduct your prosthesis as a medical expense on your taxes. However, it has been confirmed that if medical bills exceed 7.5% of an individual’s income, then the wig is tax deductible. Still, it’s recommended though that you should discuss this with your CPA.

Unfortunately, in default policies, the Standard List of Exclusions prohibits coverage for wigs. Even so, you can ask your employer’s human resource department to renegotiate your contract to include your cranial prosthesis coverage. And if you have secondary insurance, you can contact your insurance broker to do the same.

Types of Hair Loss Covered By Insurance

  • Hair Due to Chemotherapy
  • Kidney Related Hair Loss
  • Hair Loss Caused by Cancer
  • Alopecia
  • Radiation Related Hair Loss
  • Hair Loss Due to Thyroid Problems
  • Hair Loss Due to Prescription Medicine
  • Medical Hair Loss Due to Life and Environmental Changes, Thinning and/or Balding, Genetics, Stress, Aging, Reaction to Medical Illness

The Steps You Should Take

Contact the benefits department for your health insurance and ask:

  • Does your policy cover a cranial prosthesis?
  • If it does, what type of prosthesis is covered (I.e. human hair wigs, synthetic wigs, etc.)
  • How much of the cost do they cover?
  • What specific terminology for a wig should the prescription contain?
  • Is there required documentation they need to submit your claim? What is it?

Note: When reviewing your insurance policy and you don’t see cranial prosthesis listed, it doesn’t necessarily mean you don’t have coverage. We strongly recommend that you call your health insurance company and get pre-authorization. NEXT:

  • Get a prescription for a “cranial prosthesis” from your doctor. If you have never been officially diagnosed with "Medical Hair Loss", please see a dermatologist for a diagnosis and a prescription. Make sure to use the correct terminology required by your health insurance provider and include procedure code "A9282". It’s important that the prescription does not say “wig”. Because a wig is considered a fashion item, it is not medically necessary. The procedure code/number on your cranial prosthesis prescription must be used to submit your insurance claim.
  • Have your doctor write a letter of recommendation. By having your doctor write a letter, you become more human, and not just a claimant. In the letter, your doctor can explain hair loss and its devastating effects on a recipient. Also, he/she can state that your prosthesis is not for cosmetic reasons, but for your emotional well-being. (This is recommend not required)
  • Make sure you keep copies of all your invoices and documentation from your doctor for tax exemption purposes. Don’t forget to consult with your tax advisor regarding tax deductible items and medical bills.
  • If you are going to pay out-of-pocket, upfront initially or file an insurance claim, request an appointment at CranialProthesisMedicalWigs.org.
  • After placing your appointment request, please allow 24 hours for acceptance. 
  • We will send consent forms that must be filled out prior to your consultation appointment via email. 
  • During your consultation we will fill out a wig order form. Please allow 24-48 hours for an official invoice containing a notation that states Cranial Prosthesis and our tax ID number. 
  • When we have all necessary documents we will send all documentation to your health insurance provider. This is includes your doctor’s prescription, completed insurance claim form, invoice from CranialProsthesisMedicalWigs.org, and any other necessary forms.
  • Once the claim is submitted we must wait for your insurance payment and or out of pocket payment to clear before beginning your custom made hair replacement system or “Cranial Prosthesis”.

What To Do If Your Insurance Won’t Cover Your Wig Cost

Option 1. If you’re paying for the wig yourself, save your receipt for possible tax deductible opportunities. Remember, your wig is tax deductible if your medical bills exceed 7.5% of your income.

Option 2. Speak to your social worker or doctor about local resources! Call your local division of the National Alopecia Areata Foundation, the American Hair Loss Foundation, the American Cancer Society, and other foundations. Depending on their requirements, you may be able to qualify for financial assistance toward a medical hair system purchase.

Insurance Companies and Cranial Prosthesis Coverage

 

Blue Cross Blue Shield
Wigs for hair loss due to treatment of cancer. Benefits for wigs are paid at 100% of the billed amount, limited to $350 for one wig per lifetime. Does not include cranial prosthesis.
Aetna
Reimbursement rate for participating providers of wigs (Cranial Prosthesis) diagnosis code A9282 is $1,000.
Tricare
You will need a prescription from your physician with the diagnosis code "A9282" for a cranial prosthesis to qualify for a medical wig.
Medicare
Because Medicare considers wigs to be cosmetic, they aren’t covered under Original Medicare Part A or B, even with a doctor’s prescription.
United Healthcare
Coverage for wigs, hair prosthesis is excluded unless specifically listed as a covered health care service. At Cranial Prosthesis Medical Wigs, we require clients to have a consultation with our Cranial Prosthesis specialist prior to purchase. Our goal is to provide each client with a hair replacement system that is best suitable for their needs. Once you have completed the consultation appointment request you will receive consent and price quote forms via email. These forms must be filled out prior to our consultation.
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