If you file an insurance claim for reimbursement for a “wig” instead of a “cranial hair prosthesis” you will very likely be turned down. Most insurance companies cover between 80% to 100% of a cranial hair prosthesis.
GUIDELINES FOR FILING INITIAL INSURANCE CLAIMS:
- Most insurance policies cover “Prescribed Cranial Prosthesis” but do not cover wigs.
- Insurance companies cover the cost under procedure codes S8095 and A9282
- Get a letter and/or prescription from your doctor.
- Make sure that the letter or prescription is for “Prescribed Cranial Prosthesis”
- It should not say wig-if it does, have it redone, otherwise your claim will most likely be refused.
- Have a receipt from the company you purchased the Cranial Prosthesis. Make sure it says “Prescribed Cranial Prosthesis.”
- Have the physician sign off on the insurance claim form.
WAITING FOR YOUR CLAIM TO BE PROCESSED – PREPARE YOURSELF FOR HAVING YOUR CLAIM DENIED:
- Know your rights as the insured party.
- Obtain a copy of your FULL contract with your carrier (most people only have a “Summary of Benefits” provided by the employer).
- Read and know your contract.
- Pay attention to the “exclusions” Wigs are excluded for cosmetics reasons.
- Pay special attention to Prosthesis coverage. Most policies do not spell out exclusions under Prosthesis, and this is how you are likely to have your claim accepted.
SUBMITTING YOUR APPEAL – (AFTER DENIAL OF CLAIM AS NOT A COVERED BENEFIT)
- Write asking for a review by the Medical Review Board.
- Attach copy of original claims.
- In your letter, inform them of the difference between a wig and Prosthesis. (A wig is a fashion item and not a necessity. Prosthesis is a necessity comparable to plastic surgery for a burn victim).
- Ask for a written reply. (Companies try to avoid putting anything in writing).
- Address your letter to a supervisor in the Claim Department.
Some other optional suggestions are:
a. Include a letter from your employer,
b. Take pictures of yourself without hair,
c. Hand write a letter detailing the emotional effects that your condition has had on your life.
Keep copies of your sales invoice(s) for your cranial prosthesis as your full cranial prosthesis may also be a tax deductible medical expense.
These steps are just for your reference. Remember to follow the procedures outlined by your insurance company to receive the maximum benefit possible.
GRANTS/OTHER HELPFUL INFORMATION:
If you don’t have insurance you could try to contact your state or county
agencies. The County Department of Social Services offers medical assistance in most states for individuals who meet certain income guidelines.
Applying for a Grant or Voucher to Cover your Full Cranial Prosthesis (full lace wigs): American Cancer Society has a program available to those who qualify to assist you in purchasing a wig. If your insurance does not cover the full cost of your wig or only covers partial cost of your wig, you may quality for an allotment through the American Cancer Society.
The American Cancer Society will issue you a voucher up to $75 to help cover the cost of your wig. You must meet certain financial guidelines. You MUST apply for this voucher BEFORE you purchase a wig. It will not be awarded for purchases made in advance. To inquire about getting financial assistance for your wig purchase, you can contact the American Cancer Society at 1-800-227-2345. Ask to speak to a representative in regards to: Financial Assistance for a Wig Purchase.
If you need hair system as the result of a medical hair loss condition, such as Alopecia or chemotherapy, the cost of your hair system may be covered, partially or completely, by your health insurance. Many insurance companies cover between 80% and 100% of the cost of the Cranial Prosthesis. To ensure that you qualify for coverage, you must follow the guide lines.
Consult with your doctor. Many cancer centers are familiar with local organizations that provide recycled wigs, free or at a reduced cost. We can also assist you on providing a hair system. Funds Are Not Available at this time.
For more details, contact us by Via Email at firstname.lastname@example.org Claims
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Most medical providers insurance companies cover from 80% to 100% for the expenses incurred for the purpose of purchasing your hair replacement. Some medical health care providers will authorize 1 to 3 hair replacements units per year. Ask your health care provider how many they will approve. Also, some health care providers will allow hair replacements yearly, but remember; a doctor’s prescription must always accompany your claim for a hair replacement.
With HMO’s and all new provisions some medical health care providers are turning towards, it is a good idea to call your health care provider to see if you need pre-approval from your primary care doctor.
Never file an insurance claim for a WIG! Always call it a “full CRANIAL PROSTHESIS”. Many, but not all, insurance companies attempt efforts to turn down claims for “wigs”. They should have no reason to turn down a file for a full cranial prosthesis or cranial prosthesis when it accompanies medical therapy and your doctor’s prescription. Invoices for the replacement must accompany your doctor’s prescription. Make copies of all invoices and prescriptions.
Your doctor should give you a prescription for “full cranial prosthesis”. Save this and send a copy along with your claim file.
Notify us about your medical need for alternative hair and we will bill you for a “full cranial prosthesis” as well. Save your bill.
Your emotional well-being is an important part of your medical recovery process. If you encounter resistance from your insurance company, a letter from your doctor, spelling out that he “prescribed” the prosthesis, not for cosmetic reasons, but as part of your recovery program, should suffice.
If you are still denied ask for a review by the medical review board. Add to your original claim:
Before And After Photos
A Hand Written Letter About the Emotional Necessity for Your Prosthesis
Letters from Your Employer as to Why the Prosthesis Has Improved Your Performance
Ask Why the Claim Was Denied
Note: We are not a Medical or Health Provider. We DO NOT process medical claims, nor do we accept prescriptions.
If you do not have insurance, most counties in the US have state social services departments which offer medical assistance for those who meet their financial guidelines.
The American Cancer Society will provide free hair replacements and turbans for those without healthcare. These hair replacements and head wear have been donated by individuals no longer requiring the use of a hair replacement.
Applying for a Grant or Voucher to Cover your Full Cranial Prosthesis (full lace wigs):
File an Insurance Claim for a Medical Lace Wig/Cranial Prosthesis
Use Your Insurance Benefits to Purchase a Medical Lace Wig Today!
Use Your Benefits to Purchase Any Medical Wig on Fashion Lace Wigs
-Insurance Claim – We can file an Insurance Claim for all Major Providers including Aetna, Blue Cross, Cigna, Humana, Tricare and United Healthcare and more. We are also able to file claims with most local and smaller providers.
-Flexible Spending Account – We are able to accept all types of HSA and Flexible Spending Accounts towards the purchase of your Medical Cranial Prosthesis.
Option 1 – File an Insurance Claim – Use your Medical Insurance Coverage to purchase a Cranial Prosthesis from Fashion Lace Wigs Hair
If you have a medical insurance plan, you should be covered to receive a medical wig for hair loss. At Fashion Lace Wigs Hair we will have a representative to contact you first to discuss your medical hair needs. If your hair loss is a result of a medical condition, we will make the necessary calls and file the claim on your behalf to help you get a medical wig at little to no cost to you. Below is our contact form, for a phone consultation. In most cases, if there is a medical need and insurance is in place, we can file your claim we will process the claim on your behalf. Therefore, we do all the paper work within 1-2 business days,.
The actual coverage amount will be determined by your insurance company. Most insurance companies will cover only a portion that usually starts around $300 & goes up to the thousands. If you choose an item that exceeds the amount of coverage that is provided by your insurance provider, you can pay the difference for the unit.
Option 2 – Flexible Spending Account or Health Savings Account – Use your FSA or HSA Benefits to purchase a Cranial Prosthesis from Fashion Lace Wigs Hair
Our second option for coverage is via your Health Savings Account or Flexible Spending Accounts. If you have either a HSA/FSA account and medical hair loss, you can use these benefits to purchase a medical wig from us. You can also complete the short form below & we will call and discuss your options.
To ensure the claims process is as smooth as possible
please do the following:
– First, check the ‘Benefit Booklet’ given you by your insurance carrier. This lists in detail all of the covered expenses under your particular plan. Look for the section under ‘Covered Expenses’ relating to ‘prosthesis’ or ‘prosthetic devices.’ Or you can contact your insurance carrier to ask about coverage for to ‘prosthesis’ or ‘prosthetic devices’.
– Obtain a written “PRESCRIPTION” for “CRANIAL HAIR PROSTHESIS” from your doctor/treating physician. On this prescription, have your doctor to include your specific diagnosis. (For Example: If you have been diagnosed with Alopecia, there are different types. Have your doctor to be very detailed and to include the exact strand/type of medical condition that has caused your hair loss.
– Also, request a separate detailed letter from your doctor explaining the extent of your hair loss and the mental distress you have experienced due to your medical treatment (the effects on your daily life). A brief letter from a psychiatrist or psychologist may also be beneficial, if available.
– Take pictures of your hair WITHOUT a wig on. This will immediately show that your claim is not for cosmetic purposes.
– Write a personal letter of your own explaining/outlining the effects that hair loss has had on your daily life. Detail the emotional effects that your condition or your medical treatment has had on your life. Discuss the financial aspects of frequent wig purchases. Advise that a cranial prosthesis is just as medically necessary as a prosthetic limb or breast: it replaces a missing body part hair. Explain the benefits of purchasing this type of prostheses (it is made to order, perfect fit, more natural, etc.). Explain that although the initial cost of a custom prostheses is higher, it will also last several years, thereby being a cost-effective item.
– You will provide all the above to our company. We will then contact you so that we may submit your claim to your insurance provider.
– The entire process to filing an insurance claim can take a total of 7-10 business days.
We are very familiar with this process and we want to get your medical wig to you as soon as possible. We will submit your claim correctly the first time to ensure there are no mistakes from the start.
To get started please fill out the form below. We will help you with everything from there. We will process the claim on your behalf. Therefore, we do all the paper work.
Re: Financial Assistance for a Wig Purchase
SEND ALL DETAILS TO US..WILL WORK ON PROCESSING YOUR CLAIM.