How to File a Medical Insurance Claim for your Wig and/or Hairpiece

If you are like so many of the men and women out there that need a wig for a medical reason (Cancer-related or Alopecia), you may be eligible for reimbursement from your current health insurance provider. Most insurance companies will cover between 80-100% of the purchase price of a wig or hairpiece for medically related hair replacement purposes. The trick is knowing what insurance companies look for. A claim submitted with the term "wig" will more than likely be rejected by insurance companies because it is seen as a cosmetic expense while referring to the same product as a "Cranial Hair Prosthesis" necessary for medically related hair loss will just as often result in a paid claim as a medical necessity. Along with submitting a written prescription from a medical professional, it is important to send a personal note detailing the psychological effect of hair loss on you.

Double-check your insurance claim form to make sure you legibly included the following elements:

1. Diagnosis Code from your doctor
Receive a letter or prescription from your doctor for a “Cranial Hair Prosthesis.” A prescription should include a diagnosis code. We will use this code when generating an invoice for a submission to your insurance company.
2. HCPCS(Healthcare Common Procedure Coding Systems) Codes
  S8095 : Wig for medically-induced or congenital hair loss
  A9282 : Wig, any type
  D5924 : Cranial Prosthesis

*Please contact your insurance provider for which code to use.

3. NPI(Natioanl Provider Indentifier)
Insurance companies also ask for an NPI, which comes from the company where you purchased your Cranial Hair Prosthesis. *We can help with this.
4. Receipt from the company
Have a receipt from the company where you purchased your Cranial Hair Prosthesis. Ensure it does not say “wig” anywhere and includes the HCPCS code. *We can help with this.
5. Tax ID# of the company
Have the tax ID# of the company where you purchased your cranial hair prosthesis. *We can help with this.
6. Your physician’s signature
Have your physician sign off on the insurance claim form.

Appealing a Denied Insurance Claim

Due to the differences in every individual's insurance policy, this may not work for everyone. This guideline is just for you to reference and to show you how to research if your insurance company covers "Cranial Hair Prosthesis" or something similar. Make sure you review and understand the procedures outlined by your insurance policy as they may differ between carriers. Keep copies of all documentation including the receipt/invoice for your Cranial Hair Prosthesis (may even be a tax-deductible medical expense).

1. Know your rights and be informed
Obtain a complete copy of your full contract with your insurance company. Your insurance policy can often be found online through your provider's website.
2. Cranial Hair Prosthesis
Carefully read and understand the exclusions (“wigs”) and covered items (“Cranial Hair Prosthesis”) in your policy. See if your insurance policy calls it something other than “Cranial Prosthesis.”
3. Write a letter to the Medical Review Board asking for a review.
  Be sure to attach a copy of the original claim.
  Emphasize that a wig is a cosmetic item and unnecessary. A prosthesis, however, is necessary (comparable to plastic surgery for a burn victim).
  Address your letter to a supervisor in the Claim Department and ask for a written reply.
4. Some other suggestions are:
  Include pictures of yourself without hair and a letter detailing the emotional effects your hair loss has had on your life
  Include a letter from your employer
  Understand which medical codes to use on your forms. Different conditions may require different diagnosis codes. Check with your prescribing physician for the codes related to your condition.

* Contact Artistic Wigs & Hairpieces for additional information or to obtain your properly itemized receipt if you bought your wigs and hairpieces from us. We are happy to help with this, and can email you a .pdf copy of your invoice.

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• Call us at (805)603-2236 ; Mobile or (805)482-4848 ; Land