Insurance Covers Wigs?! - Explained by a Dermatologist
As dermatologists, we understand the impact hair loss can have on your self-esteem and quality of life. Prescription wigs, also known as cranial prostheses, can be a valuable option for people with medical hair loss. Here, we’ll guide you through the process of obtaining a prescription wig and explain how insurance may help cover the costs.
Watch the video to the right, or read on for more!
Hair Loss + Wigs
Hair loss can be challenging, affecting not only how you look but also how you feel. Prescription wigs, or cranial prostheses, are specially designed hairpieces made for those experiencing medical hair loss due to conditions like alopecia, chemotherapy, or other medical treatments. Unlike fashion wigs, prescription wigs are considered a medical device, which is why they may be covered by health insurance if specific conditions are met. This guide will help you understand the steps involved in obtaining a prescription wig, including how to talk to your dermatologist, work with your insurance, and find the right provider.
Understanding Prescription Wigs
A prescription wig, also called a cranial prosthesis, is a specially designed hairpiece for individuals who have lost hair due to medical reasons. This could include conditions like:
Alopecia: An autoimmune disorder that leads to hair loss.
Chemotherapy-induced hair loss: Many cancer patients experience hair loss as a side effect of chemotherapy.
Radiation therapy: Radiation treatment for cancer can also cause hair loss.
Burns or trauma: Physical damage to the scalp can result in permanent hair loss.
Other medical conditions: Some metabolic or hormonal conditions may also lead to hair loss.
Prescription wigs are made to fit comfortably and naturally, providing a secure and realistic option for those dealing with medical hair loss. They differ from regular wigs in terms of construction and quality, focusing on comfort, durability, and a natural appearance.
Here's how to get coverage through your insurance, with a free PDF worksheet to help you through the process.
Step 1: Check Your Insurance Coverage
The first step in obtaining a prescription wig is to check with your health insurance provider. Not all policies cover wigs, but some do when they’re classified as a “cranial prosthesis.” Here are some key questions to ask your insurance company:
Is a hairpiece covered under my plan? It may be listed as a prosthetic device, durable medical equipment, or under a similar category.
What type of wig is covered? Some plans may cover only synthetic wigs, while others may allow for human hair options.
How much of the cost is covered? Ask if insurance will pay upfront or if you’ll need to pay first and seek reimbursement.
What specific diagnosis is needed? Insurance may require an ICD-10 code (a medical diagnosis code) related to hair loss.
What should the prescription include? Many insurance companies won’t accept “wig” as the description; instead, the prescription should say “cranial prosthesis.”
Which billing code should be on the prescription? Common billing codes include A9282, D5924, or S8095.
It’s important to get clear answers to these questions, as they’ll determine how you proceed. Some insurance companies may have strict requirements about terminology and documentation, so knowing these details upfront can make the process smoother.
Step 2: Get a Prescription from Your Dermatologist
Once you have a clear understanding of your insurance requirements, schedule a visit with your dermatologist. To ensure that the prescription meets your insurance company’s standards, bring a list of what the prescription should include:
Term “Cranial Prosthesis” instead of “wig.”
Diagnosis and ICD-10 code related to your medical condition.
Billing Code: Often A9282, D5924, or S8095, but confirm this with your insurance provider.
Your dermatologist can assess your condition and provide the required medical documentation. If this is their first time writing a prescription for a wig, feel free to provide guidance based on the information you gathered from your insurance company.
Step 3: Find a Hairpiece Provider
Once you have your prescription, you’ll need to find a provider who supplies cranial prostheses. Some insurance companies require you to use an “in-network” provider, so be sure to check if this applies to you. If your preferred provider is out-of-network, ask your insurance company if they allow exceptions for cranial prostheses.
When choosing a provider, consider the following factors:
Quality of materials: Synthetic vs. human hair, comfort, and durability.
Customization options: Some providers offer custom fittings to ensure a secure and comfortable fit.
Experience with medical wigs: Providers specializing in cranial prostheses are often more experienced in meeting medical and insurance requirements.
Step 4: Purchase Your Wig and Keep Detailed Records
After selecting your hairpiece provider, it’s time to make your purchase. Make sure your receipt includes essential details, as these will be required by your insurance company for reimbursement:
Purchase date
Company name and address
Tax ID of the provider
Description of the product (e.g., type of hairpiece)
Total cost, including tax
Keeping a detailed receipt ensures you have the necessary proof of purchase for your insurance claim. If possible, ask the provider if they are experienced with insurance claims for cranial prostheses, as they may offer additional help.
Step 5: Submit Documents to Your Insurance Company
To apply for reimbursement, gather the required documents and send them to your insurance company. Most insurance providers require:
Medical Claim Form #1500: You can typically download this form from your insurance provider’s website.
Prescription: Ensure it uses the term “cranial prosthesis” and includes the diagnosis and billing code.
Receipt: This should include all the details mentioned earlier.
Before submitting your claim, make copies of everything for your records. If sending by mail, consider using certified mail to ensure it’s received. Be prepared to follow up with your insurance company if you don’t hear back in a timely manner.
Additional Tips for Success
Here are some practical tips to help you through the process:
Document your calls: Note the date, time, and name of any insurance representative you speak with.
Keep copies of all documents: It’s helpful to have a backup in case anything is misplaced.
Don’t hesitate to follow up: Insurance claims can take time, so reach out if you haven’t received a response.
Consider certified mail: If sending documents by mail, certified mail offers a tracking option to confirm delivery.
Navigating insurance for a prescription wig can feel complex, but following these steps and staying organized can make it much easier.
Prescription Wig FAQs
What insurance companies cover cranial prosthesis?
Many insurance companies cover cranial prostheses (medical wigs) when prescribed by a doctor for medical conditions such as alopecia, chemotherapy-related hair loss, or burns. Coverage varies by provider, so contact your insurance company to confirm benefits.
What is a cranial prosthesis?
A cranial prosthesis is a custom-made medical wig designed for individuals experiencing hair loss due to medical conditions or treatments, such as cancer, alopecia, or burns. It is crafted to fit comfortably and look natural while addressing the specific needs of the wearer.