Wigs for Patients with Medical Hair Loss FAQ's

Certain individuals undergoing chemotherapy treatment may choose to embrace their newly bald crown and leave it exposed, while others may opt for a more comfortable wig. There are no incorrect decisions.

While anticipating hair loss, the experience of seeing it occur can still be surprising. Preparation for hair loss might make this transition smoother. Being prepared with a wig in advance (even if just for special occasions) can offer support.

Wigs can be costly, but insurance might cover the expense if hair loss is due to medical reasons.  Allow us to assist you in navigating how to seek reimbursement for a wig and explore alternative options if insurance does not provide coverage.

 

Wig Hair Options

Wig hair comes in many different colors and styles to suit your personal preference. There are two types of wig hair:

  • A wig made from synthetic hair has strands created from polymers, which can hold a style through wear and shampoo. There are many types of synthetic wig hairs, and some can easily melt near heat sources. 

  • A real human hair wig can be colored, permed, cut, styled, and blow-dried, just like your own hair. They are made from 100% human hair and will need to be restyled after each shampoo.

    


Understanding Health Insurance Coverage for Medical Wigs

If you are experiencing hair loss whether temporary or permanent due to medical reasons, you can qualify for an insurance covered wig. Unfortunately, not many people know this. 

Wig hair is graded by strength, elasticity, and porosity. The better the hair quality, the greater your cost, and with care, the longer you will be able to wear the wig. Consider how long you might need to wear a wig before you decide what you want to spend on it.

A wig can cost from $40 to thousands of dollars. But when your budget is already strained by the cost of surgery and other cancer treatments, even something on the lower end of that spectrum may seem out of reach

What is a Cranial Prosthesis?

A cranial hair prosthesis is the medical term used for wigs for patients who have lost their hair due to medical conditions. These conditions include chemotherapy, alopecia totalis, alopecia areata, trichotillomania, and other conditions resulting in hair loss.

It’s important to know the terminology when applying for medical insurance or tax deduction status. Other common terms used to describe a medical wig include: cranial hair prosthesis, hair prosthesis, and full cranial prosthesis. NEVER refer to this item as a "wig" on medical documents. It will sound as if you are purchasing something for fashion, as opposed to medical needs. 

Billing Code: A9282 “Wig, Any Type, each”
Billing Code: D5924 “Cranial Prosthesis”

Every state sets its unique reimbursement rules. Here's California's exclusive link!
Link to California Assembly Bill AB 2668

https://www.chbrp.org/sites/default/files/bill-documents/AB2668/20230AB2668_99_0.pdf

When obtaining a medical prescription, the most commonly used codes are A9282 (synthetic wig) and L8499 (human hair wig). Ensure your doctor writes the Rx for a 'Medical Hair Prosthesis' or 'Cranial Prosthesis” (NOT a wig), and make sure they include your diagnosis code. If your prescription states a "wig", it will be denied since this word is deemed a fashion item and not a medical necessity. 

 

    

Your Insurance Will Let You Know If You’re Covered

Whether or not your medical wig is covered by your insurance company depends on your plan. But it’s possible to receive full payment for your full cranial prosthesis. However, while some insurance companies will pay for your prosthesis upfront, others require you to pay upfront and then get reimbursed.

Many insurance companies cover 80-100% of the cost for your full cranial prosthesis. They also may allow one cranial prosthesis per year for medical hair loss. Additionally, you may also be able to deduct your paid portion of the prosthesis as a medical expense on your taxes. However, it’s recommended that you should discuss this with your CPA.

 

    

 

Types of Hair Loss Covered By Insurance

  • Hair Due to Chemotherapy
  • Kidney Related Hair lLoss
  • Hair Loss Caused by Cancer
  • Alopecia
  • Radiation Related Hair Loss
  • Hair Loss Due to Thyroid Problems
  • Medical Hair Loss Due to Life and Environmental Changes, Thinning and/or Balding, Genetics, Stress, Aging, Reaction to Medical Illness

Medical conditions such as thyroid disease, alopecia areata, and scalp infections (ringworm) can cause hair loss.

Medications used to treat cancer, arthritis, depression, and high blood pressure can also induce hair loss.

 

     

The Steps You Should Take

Contact the benefits department for your health insurance, or your insurance company and ask:

  • Does your policy cover a cranial prosthesis?
  • If it does, what type of prosthesis is covered (i.e. human hair wigs, synthetic wigs, etc.)
  • How much of the cost do they cover?
  • What specific terminology for a wig should the prescription contain?
  • Is there required documentation they need to submit your claim? What is it?

Note: When reviewing your insurance policy and you don’t see cranial prosthesis listed, it doesn’t necessarily mean you don’t have coverage. We strongly recommend that you call your health insurance company and get pre-authorization.

NEXT:

  • Get a prescription for a “cranial prosthesis” from your doctor. Make sure that’s the correct terminology required by your health insurance provider. Also, include procedure code A9282. It’s important that the prescription does not say “wig”. Because a wig is considered a fashion item, it is not medically necessary. The procedure code/number on your cranial prosthesis prescription is used to submit your insurance claim. It would also be helpful to obtain a letter of medical necessity from your physician. 

  • Make sure you keep copies of all your invoices and documentation from your doctor for tax exemption purposes. Don’t forget to consult with your tax advisor regarding tax deductible items and medical bills.

  • If you are going to pay out-of-pocket or upfront initially, place your order online at UyleesBoutiqueandHair.com, or over the phone at 1-916-426-3379. When placing your online order, you will immediately receive an invoice via email. This invoice can be used to request either reimbursement, or request payment depending on your insurance company. 
  • We will provide you with your invoice containing a notation that states Cranial Prosthesis and our tax ID number.

  • Send all documentation to your health insurance provider. This is includes your doctor’s prescription, completed insurance claim form, invoice from UyleesBoutiqueandHair.com, and any other necessary forms.


What To Do If Your Insurance Won’t Cover Your Wig Cost

Option 1. If you’re paying for the wig yourself, save your receipt for possible tax deductible opportunities. 

Option 2. Speak to your social worker or doctor about local resources! Call your local division of the National Alopecia Areata Foundation, the American Caner Society, and other foundations. Depending on their requirements, you may be able to quality for financial assistance toward a wig or hair system purchase.


If you do not have insurance, you may qualify for a grant or voucher

There are organizations that help provide financial aid for people who are facing hair loss due to a medical condition. Contact your state or county 
agencies. The County Department of Social Services offers medical assistance in most states for individuals who are below certain income levels.


NAAF’s Ascot Fund

NAAF’s Ascot Fund is a financial assistance program to help adults and children with Alopecia Areata purchase a hairpiece. The maximum amount awarded is $500, and the applicant needs to be able to pay any balance beyond the awarded amount.

You are eligible for the ascot fund if you meet the following requirements:

  • Have been diagnosed with Alopecia Areata by a dermatologist or doctor
  • Are unable to purchase a hairpiece due to financial challenges
  • Are not already in possession of the hairpiece for which you are applying

OR have not already paid for the full balance of the cost of the hairpiece

For more information visit www.naaf.org.


Insurance Companies and Cranial Prosthesis Coverage (this information may have changed at any time)

Blue Cross Blue Shield
Wigs for hair loss due to treatment of cancer. Benefits for wigs are paid at 100% of the billed amount, limited to $350 for one wig per lifetime.

Aetna
Reimbursement rate for participating providers of wigs (cranial prostheses) diagnosis code A9282 is $1,000.

Tricare
You will need a prescription from your physician with the diagnosis code A9282 for a cranial prosthesis to qualify for a medical wig.

Medicare
Because Medicare considers wigs to be cosmetic, they aren’t covered under Original Medicare Part A or B, even with a doctor’s prescription.

United Healthcare
Coverage for wigs, hair prosthesis is excluded unless specifically listed as a covered health care service.

Additional Insurance Companies

  • John Hancock Insurance Company
  • Metropolitan Life (80%)
  • Blue Cross Blue Shield (80 to 100%)
  • Metropolitan Educator of New York (80 to 100%)
  • Prudential Life Insurance (80 to 100%)
  • C.I.G.N.A. Emerald Health Network (100%)
  • Med Choice Provident Mutual (80%)
  • Equitable Life Aetna (80%)
  • Midwest Benefits Corp

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