If you need to wear a wig because of medical reasons like Alopecia and
cancer-related therapy that the "wig" should be called a "cranial hair
prosthesis" for insurance purposes?
If you
file an insurance claim for reimbursement for a "wig" instead of a
"cranial hair
prosthesis"
you will very likely be turned down?
Most
insurance companies cover between 80 to 100% of a cranial prosthesis?
Insurance Companies
are realizing your cranial hair prosthesis are more and more a necessity for
those recovering from Alopecia and cancer treatments.
Follow some simple guidelines to assure coverage,
when it is available through your insurance company.
Your physician should be able to supply all the
details and make the referral for the purchase of your "hair prosthesis". Ask
your physician to do that.
When receiving your hair prosthesis, have your
stylist complete an invoice for a "cranial hair prosthesis" NOT a wig and use
the following guidelines for filing an insurance claim.
- Check the benefits of your insurance. There
should be a section under "covered expenses" relating to prostheses,
prosthetic devices or medical durable equipment. Most companies don't spell
out exclusions so pay attention to the actual coverage. this will help your
case.
- Make sure to complete the insurance form and
have it signed by your physician.
- Request that your physician write a
"prescription" for a "full cranial prosthesis" (not a wig) and a letter
explaining hair loss and its effects. That it isn't just for cosmetic
reasons but for emotional well-being as well.
- Keep copies of your sales or invoices for your
cranial prosthesis. (Portions of unpaid items by insurance are tax
deductible.)
- Enclose a letter to the insurance company
stating the necessity of a prosthesis.
- Some optional suggestions are
- include a letter from your employer,
- take pictures of yourself without hair,
- hand write a letter detailing the emotional effects that your condition has
had on your life,
- bring a copy of your prescription and paid bill tot he American Cancer
Society for partial reimbursement.
- If your insurance coverage is denied, you can
appeal it:
a. ask for review by a medical review board, include the original claim
b. ask for a
written reply as to why the claim was denied.
c. send a
letter tot he claims department supervisor.
These steps are for reference. Remember to follow
the procedures outlined by your insurance company to receive the fullest
benefits possible. Most companies cover between 80 to 100%. Individual insurance
companies as well as the state insurance board (each state varies) may have
other or additional steps to complete.
If you don't have insurance contact your state or
county agencies. The county department of social services offers medical
assistance in most states for individuals who meet certain income guidelines.
For more information on this subject go to
http://www.wigindustry.com/102508c.htm
There are a number of fantastic
suppliers you can work with to get what you need at http://www.aaawigbiz.com/index-medical.htm
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Frequently Asked Questions
1.
What is a Cranial
Prosthesis
2 Do you know what insurance
company between Aetna, Hip or United Healthcare covers the cranial hair
prosthesis. I am a woman with Alopecia Universalis and making my decision
to change insurance companies. Barbara
1.
What is a Cranial Prosthesis
1. A Cranial Hair Prosthesis is medical insurance jargon for a hair system for
those suffering from hair loss due to medical conditions. Prostheses contain a
combination of fabrics and compounds that are used to re-create natural hair
growth patterns and the look of the scalp. All materials in the prosthesis are
designed to provide maximum comfort.
Cranial hair prosthesis are different from budget
or department store wigs in quality. performance, and service. Prostheses are
made of specialized material - sensitive to the needs of the individual. The fit
is adjustable to each person's size and also custom cut and styled. A department
store wig (budget wig) has a set style - what you see is what you get. Service
plays an important role when selecting a hair prosthesis.
When looking for hair loss options, you need to
decide what will best fit your needs -
wigs,
hats or turbans,
integration hair pieces,
hair replacements, or a
custom wig.
A
Medical Specialist can help you decide
2 Do you know what insurance
company between Aetna, Hip or United Healthcare covers the cranial hair
prosthesis. I am a woman with Alopecia Universalis and making my decision
to change insurance companies. Barbara
Your question is one that is not easily answered, as each company has the option
to determine what it will or will not cover with respect to durable medical
equipment. You will need to review each company's policy to know what it does
cover. If you are purchasing this insurance as a private individual, you could
ask for a rider to be put on the policy specifically covering cranial
prosthesis; however, you may be required to wait a length of time as the need is
due to a pre-existing condition. If you are choosing this insurance as a benefit
from your employer, chances are it is not covered by either of the companies you
have mentioned as Alopecia is considered an "orphan" disease due to the few
people per total population afflicted. Those of us, like me and you, who are
afflicted do not see the difference between an ocular prosthesis, which does not
provide a biological function, and a cranial prosthesis, which also does not
provide a biological function, although most insurance companies will cover
glass eyes.
Take heart in knowing there are people who are putting pressure on insurance
companies to cover the cost of a cranial prosthesis, and you can always write to
your congressman, senator and state insurance commissioner about your needs.
Thank you very much for your question,
Sincerely, Kimberly Belk (AA/AGA 15 years
belkwigs.com
3. I have
obtained a prescription from my dermatologist for a full cranial
prosthesis, does the prescription need to read full cranial hair
prosthesis?, and can I have a phone number of the shop that fill
the prescription. The full cranial prosthesis is covered by my
medical plan, however I don't have a company to fill the order
nor product.
Whether it says "cranial prosthesis" "cranial hair prosthesis"
"full cranial hair prosthesis" shouldn't make any difference.
However, insurance companies are on the lookout for ways to
avoid paying any money out. What does you policy say it covers?
If it says "cranial hair prosthesis" then your prescription
should read the same way to avoid having it kicked back for an
error in the prescription and delaying getting paid.
Also, you say you received a prescription but, do you know that
your insurance company will actually cover the prescription for
your particular situation. Do you know what percentage they will
cover? It would be a good idea to call and talk to them on both
of these issues before you do anything.
As far as filling the prescription that is a bit of an issue.
The are no wig pharmacies per say and no wig pharmacists.
Therefore, there is no one who can fill your prescription so to
speak.
The way this works is you go to a
wig company, wig shop or wig supplier and order a wig from them.
Tall them what you are looking for and why. They may recommend a
custom wig specifically for patients with medical needs. What
ever they recommend be sure you are getting something of good
quality that will last for a good period of time and meets your
needs.
Because these dealers are not
pharmacies they don't have any contracts with insurance
companies so they will want you to pay for the product. You must
make sure that their receipt says that the product they sold you
is a cranial hair prosthesis or whatever your insurance company
requires. If they give you a receipt for a wig the insurance
company most likely won't pay for it.
Once you have both the doctors
prescription and the bill for the prosthesis in hand you send
those to your insurance company ( KEEP A COPY FOR YOURSELF) for
reimbursement.
If you did all of your homework
and first made sure your insurance will pay for it, and then
made sure all of the paperwork calls the wig by the right name
per insurance company requirements, you should get your money
back.
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