Health Insurance Coverage: Many insurance companies will cover between 80-100% of the cost for your full cranial prosthesis. However, if you request coverage for a “wig”, there are good chances that your claim will be denied. So please make sure you request a “full cranial prosthesis“.
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Your full cranial prosthesis may also be a tax deductible medical expense.
Applying for a Grant or Voucher to Cover your Full Cranial Prosthesis (full lace wigs): American Cancer Society has a program available to those who qualify to assist you in purchasing a wig. If your insurance does not cover the full cost of your wig or only covers partial cost of your wig, you may quality for an allotment through the American Cancer Society.
The American Cancer Society will issue you a voucher up to $75 to help cover the cost of your wig. You must meet certain financial guidelines. You MUST apply for this voucher BEFORE you purchase a wig. It will not be awarded for purchases made in advance. To inquire about getting financial assistance for your wig purchase, you can contact the American Cancer Society at 1-800-227-2345. Ask to speak to a representative in regards to: Financial Assistance for a Wig Purchase.
The National Alopecia Areata Foundation (NAAF): NAAF has established the Ascot Fund. This special pre-purchase program provides financial assistance toward the purchase of a hairpiece to individuals who have alopecia areata and are struggling financially. To find out if you qualify, please contact them at:
National Alopecia Areata Foundation
14 Mitchell Blvd. San Rafael, CA 94903
Guidelines for Filing Initial Insurance Claims:
- Most insurance policies cover “Prescribed Cranial Prosthesis” but do not cover wigs.
- The Insurance C.P.T code most commonly used is CPT-ORN-1.
- Get a letter and/or prescription from your doctor.
- Make sure that the letter or prescription is for “Prescribed Cranial Prosthesis”
- It should not say wig-if it does, have it redone, otherwise your claim will most likely be refused.
- Have a receipt from the person performing the service (from whom you purchase the Cranial Prosthesis). Make sure it says “Prescribed Cranial Prosthesis.”
- Have the person who performed the service signoff on your claim; i.e. the Physician’s “Dr.’s” portion of your claim form.
Waiting for your claim to be processed – prepare yourself for having your claim denied:
- Know your rights as the insured party.
- Obtain a copy of your FULL contract with your carrier (most of us only have a “Summary of Benefits” provided by the employer).
- Read and know your contract.
A . Pay attention to the “exclusions” Wigs are excluded for cosmetics reasons.
Pay special attention to Prosthesis coverage. Most policies do not spell out exclusions under Prosthesis, and this is how you are likely to have your claim accepted.
Submitting your appeal – (after denial of claim as not a covered benefit)
- Write asking for a review by the Medical Review Board.
- Attach copy of original claims.
- In your letter, inform them of the difference between a wig and Prosthesis. (A wig is a fashion item and not a necessity. Prosthesis is a necessity comparable to plastic surgery for a burn victim).
- Ask for a written reply.
- Address your letter to a supervisor in the Claim Department.