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Insurance Coverage for Wigs

Your health insurance can reimburse you 80%-100%

Did you know that many health insurance companies could reimburse you the full cost of your human hair or synthetic wig?! Valid medical conditions for “Cranial Hair Prosthesis” include Alopecia or Cancer. There is hope to start looking and feeling better with our wigs! You have been through enough, we would love to help you find a solution for your hair loss struggles. 

INSURANCE COVERAGE

When dealing with insurance companies it’s very important to use the term “Cranial Hair Prosthesis” consistently. Refrain from using the word "WIG."  When claims are submitted with the term “Wig” they will get denied because a wig is technically looked at as a cosmetic purposes. Referring to the same product with the term “Cranial Hair Prosthesis” which is necessary for medically related hair loss will result in a paid claim because it is considered a medical necessity. Don't forget to double check your insurance benefits and coverage to ensure “Cranial Hair Prosthesis” is covered.

HOW TO FILE YOUR CLAIM

1. Get a prescription and letter from your doctor for “Cranial Hair Prosthesis":

  1. Request your physician to write a letter explaining hair loss along with all it’s emotional effects. Cranial prosthesis is not for cosmetic reasons, it’s for emotional well-being!
  2. Please be sure your doctor states specific diagnosis codes. For example, Alopecia alone is not a diagnosis.  Alopecia Totalis, Alopecia Areata, Alopeicia Universalis, etc. are all considered valid diagnosis conditions.
  3. Use the Healthcare Common Procedure Coding Systems (HCPCS) codes: S8095 and A9282.
  4. Make sure that your doctor states why this Cranial Prosthesis is considered DME (Durable Medical Equipment)

 2. Complete the necessary forms for your insurance company

  • Contact your insurance company and ask for necessary forms to start this process
  • Use the Healthcare Common Procedure Coding Systems (HCPCS) codes: S8095 and A9282.
  • 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.
  • Have your physician sign off on your insurance claim form.

3. Submit the custom invoice we give you.

EMAIL US and We will customize an invoice that will specifically state “cranial hair prosthesis” and not a wig. Lit Unicorns will provide this invoice for you. We’ll make sure it does not say “wig” anywhere on the invoice, that it includes the necessary HCPCS insurance codes, and includes our Tax ID # which is required.

4. Hand-write an emotional letter explaining your situation

  • List all the details of the effects that your condition has had on your personal life and the necessity for the Cranial Hair Prosthesis in your life. (i.e. self-esteem, grief/depression, anxiety, daily activities, relationships.)
  • Take pictures of yourself without hair and without makeup to submit.

3. Enclose these additional extra items to reinforce your claim:

  • Include photos of yourself without hair or a wig and without makeup. Show the wig is not for cosmetic purposes.
  • Include a letter from your employer explaining the importance of having hair
  • If you’re not comfortable asking your employer someone close to you, relative, or spouse. 

 

DID YOU GET DENIED? FILE AN APPEAL

  1. Double check your benefits and coverage to make sure “Cranial Hair Prosthesis” is covered in your policy. See if your insurance company calls it something else and learn how “wigs” are excluded from coverage.       
  2. Ask for a review by a medical review board, and also include the original claim.
  3. Ask for a written reply explaining as to why the claim was denied.
  4. Send a letter to the he claims department supervisor.

Please understand that this information is meant as a guideline, the suggestions here may not work for everyone. Please go and make sure you review your benefits and coverage for your particular insurance carrier. Research the medical codes and conditions to see if you qualify. Keep copies of all documentation, and please let us know if you have any questions. We are happy to help.

 

GRANTS & VOUCHERS

American Cancer Society

Apply for a Grant or Voucher up to $75 to cover your Cranial Hair Prosthesis (must apply before purchasing a wig)/ You must meet certain financial guidelines and apply for this voucher before you purchase a hair system. They will not issue vouchers retroactively for purchases.

For more information, contact:

American Cancer Society
Call 1-800-227-2345
Website: http://www.cancer.org

 

National Alopecia Areata Foundation (NAAF)

This foundation has established the Ascot fund, which is a special pre-purchase program that provides financial assistance for individuals who have alopecia areata.

To find out if you qualify, please visit:

National Alopecia Areata Foundation
14 Mitchell Blvd. San Rafael, CA 94903
E-mail: info@naaf.org
Web site: http://www.naaf.org/

 

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