How To Have Your Wig Covered By Medical Insurance
Welcome to the Wig Expert Medical Wig Insurance Coverage Guide! This section is for clients who are purchasing a wig for medical purposes. Can insurance help purchase a wig? The answer is yes, but it takes a bit of work to find out if you’re qualified, and if your health insurance policy is among the many that offer this option. Below, explore our comprehensive guide to medical wig insurance claims.
Can Health Insurance Cover the Cost of Your Medical Wig?
Are you experiencing temporary or permanent hair loss from illness or genetics? Very few people know this, but when you lose your hair due to medical reasons such as chemotherapy, alopecia, trichotillomania, or other medical conditions, you can file an insurance claim to receive a partial or full cost of your cranial prosthesis.
What is a Cranial Prosthesis?
A cranial prosthesis is a wig for medical patients who have permanent hair loss (such as alopecia areata, alopecia totalis, trichotillomania), or temporary hair loss resulting from treatment for chemotherapy, radiation, or any other clinical disease.
The term, cranial prosthesis, is used when applying for medical insurance or tax deduction status. Other common terms for a wig used for medical purposes include: full cranial prosthesis, hair prosthesis, cranial hair prosthesis, extra-cranial prosthesis.
Note: Since the above processes are an ongoing condition, you may be eligible to receive full or partial coverage to purchase the full cranial prosthesis by your health insurance company.
Your Coverage Depends on Your Insurance Plan
For medical hair loss, you may obtain payment for the full cranial prosthesis. Depending on your policy, some insurance companies will require you to pay upfront and then be reimbursed, others will pay for your prosthesis upfront.
Most insurance companies will cover between 80-100% of the cost for your full cranial prosthesis and will allow you to receive one cranial prosthesis per year for medical hair loss. Depending on your insurance, your prosthesis may also be a tax deductible medical expense. We confirmed with an insurance representatives that if a person's medical bills are over 7.5% of their income, then the wig would become tax deductible. However, the individual should discuss this with their tax advisor first.
Through research, we discovered that in default policies there is no coverage for wigs as they are part of the Standard List of Exclusions. However, you can contact your employer's HR department or your insurance broker to renegotiate your insurance contract to include your cranial prosthesis coverage.
Most Types of Medical Hair Loss Covered By Insurance
- Alopecia Hair Loss
- Chemotherapy Related Hair Loss
- Radiation Related Hair Loss
- Thyroid Related Hair Loss
- Kidney Related Hair Loss
- Cancer Related Hair Loss
- Medical Hair Loss Due to Genetics, Stress, Reaction to Medical Illness, Life and Environmental Changes, Aging, Thinning, and/or Balding
Steps to Follow - The Process - Steps You Should Take
Contact your Health Insurance Provider's Benefits Services and ask:
- If your policy covers a cranial prosthesis
- If yes, what type of cranial prosthesis is covered (i.e. synthetic wigs, human hair wigs, etc.)
- How much of the cost will they cover
- What specific terminology they need to have on the prescription for a wig
- What specific documentation they need to submit your claim.
Note: If you are reviewing your insurance policy and do not see cranial prosthesis listed, this does not automatically mean that you don’t have coverage. We highly recommend calling your Health Insurance Provider and getting pre-authorization.
- Request and obtain a prescription for a “cranial prosthesis” (or the specific terminology required by you Health Insurance Provider) from your doctor or physician including the medical procedure code A9282. Make sure the prescription does not say “wig.” A wig is a fashion item and is therefore not medically necessary. Your prescription will include a procedure number/code for your cranial prosthesis that will be used to submit your insurance claim.
- Add an extra touch: Ask your physician to also write a letter explaining hair loss and its effects and have her/him state that it is not simply for cosmetic reasons but for emotional well being.
- Keep copies of all of your documentation and invoices from your physician for tax exemption purposes. You will need to your tax advisor first about medical bills and tax deductible opportunities.
- If you are planning on paying upfront or out of pocket initially, place your order online at Wigs.com or over the phone at 1-800-581-2001.
- Once you place your order with Wigs.com, email email@example.com with your order number and say that you need a copy of your invoice for your cranial prosthesis prescription.
- We will provide you with a copy of your invoice with a notation on the bottom that states Cranial Prosthesis and Wigs.com’s Tax ID number.
- Send all documentation (your doctor’s prescription, copy of your invoice from Wigs.com, completed insurance claim form, and any other necessary forms) to your Health Insurance Provider.
If Your Insurance Won't Help Cover the Cost of Your Wig
Option 1: When paying for your wig out of pocket, save the receipt just in case your purchase qualifies as a tax deduction. If a person's medical bills are over 7.5% of their income, then the wig would become tax deductible.
Option 2: Talk with your doctor or social worker about local resources! Contact your local chapter of the American Cancer Society, National Alopecia Areata Foundation (NAAF), and other foundations about qualifying for financial assistance toward the purchase of a hair piece or wig.
We need your help! If you’ve received a wig with the assistance of your insurance company, we’d love to hear from you! Please contact firstname.lastname@example.org, so we can feature your experience.
Insurance Companies and Their Cranial Prosthesis Coverage
Feedback from Client: "I have blue cross blue shield insurance. I have a prescription from my doctor for a wig/cranial prosthesis and blue cross would not cover the cost because my hair loss was not due to 'chemotherapy or burn'. It had to be specifically one of those two things."
Feedback from a company's Health Care Advocate: "[An employee] has been diagnosed with cancer and is going through Chemo currently which is resulting in a loss of hair. We have confirmed with Aetna that [a] wig prosthetic [is] covered under the member's plan. Aetna advised they would need your company crediting information and a CPT code for the wig prosthetic."
Information provided in this is based on U.S. Health Insurance Companies only. Information updated on August 7, 2020.