If your policy covers a cranial prosthesisIf yes, what type of cranial prosthesis is covered (i.e. synthetic wigs, human hair wigs, etc.)How much of the cost will they coverWhat specific terminology they need to have on the prescription for a wigWhat 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 sales@wigs.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.
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.
Blue Cross Blue Shield does not cover wigs as a cranial prosthesis for group and individual insurance plans.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."
Aetna's group medical insurance plan does not cover wigs as a cranial prosthetic. However, individuals should verify with Aetna that the individual plan they are on will cover this item or not. 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."
United Healthcare does not cover cranial prosthesis under group medical insurance plans. However, individuals should verify with United Healthcare that the individual plan they are on will cover this item or not.
Medicare will not pay for a cranial prosthetic wig even if the claim is filed under durable medical equipment. This means that anyone over 65 years old that has a medicare advantage plan or a medicare supplement plan, these plans will not pay for a wig. This has been confirmed by a Medicare Representative.
Ambetter does cover cranial prosthetic wigs under individual policy plans. Check with your insurance representative to see if your plan includes cranial prosthesis coverage.
Oscar does cover cranial prosthetic wigs under individual policy plans and group medical plans. Check with your insurance representative to see if your plan includes cranial prosthesis coverage.
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