Welcome to Sheitels.com!
We provide a detailed guide for those seeking insurance coverage for a cranial prosthesis. If you're purchasing a wig for medical reasons, this guide is specifically tailored for you.
Understanding Medical Wig Insurance Coverage
- Health Insurance Coverage: Many health insurance policies cover medical wigs, also known as cranial prostheses, for hair loss due to conditions such as alopecia, chemotherapy, and others.
- Extent of Coverage: This varies, but often includes partial to full costs for a cranial prosthesis. Some insurers cover 80-100% of the cost and may allow one prosthesis per year.
Defining Cranial Prosthesis
- Medical Necessity: A cranial prosthesis is a custom hair system designed for patients with hair loss due to medical conditions, not a fashion item.
- Conditions Covered: Includes chemotherapy, alopecia totalis, alopecia areata, trichotillomania, etc.
Checking Your Insurance Coverage
- Policy Review: Contact your insurance company to verify if your plan covers cranial prostheses. Pre-authorization is recommended.
- Coverage Details: Inquire about the types of prostheses covered, cost coverage, and specific requirements.
Prescription and Documentation
- Prescription Requirements: Obtain a prescription for a "cranial prosthesis," using this specific term and including the procedure code (A9282).
- Doctor's Support Letter: A letter from your doctor explaining the emotional impact of hair loss and the necessity of the prosthesis.
- Tax Considerations: Keep all invoices for potential tax deductions. Discuss with a CPA if medical expenses exceed 7.5% of your income.
Ordering and Billing Process
- Upfront Payment and NPI Number: Payment is required upfront for your prosthesis. We will provide a detailed invoice for insurance submission, including our NPI number to indicate our recognition and authorization by insurance companies.
- Invoice Details: The invoice will state "Cranial Prosthesis," include our tax ID number, and any other details you require for insurance submission.
Insurance Submission and Reimbursement
- Submit Documentation: Provide your insurance with the doctor’s prescription, insurance claim form, and all necessary documentation, including the invoice with our NPI number.
- Step-by-Step Guide for Reimbursement: Follow these steps to ensure a smooth insurance reimbursement process.
If Insurance Doesn’t Cover
- Tax Deductions and Financial Assistance: Save all receipts for potential tax deductions. Explore local resources and foundations for financial assistance.
Specific Insurance Company Policies
- Coverage Overview: Review the specific policies of companies like Blue Cross Blue Shield, Aetna, Tricare, Medicare, and United Healthcare.
Additional Tips for Coverage
- Negotiating Coverage: Discuss with your employer's HR department or insurance broker about including cranial prosthesis coverage.
- Using Secondary Insurance and Appealing Denials: Inquire about secondary insurance coverage and appeal any denials with supportive documentation.
Types of Hair Loss Covered
Insurance typically covers hair loss due to a variety of medical conditions, including chemotherapy, kidney issues, cancer, alopecia, and others.