Welcome to page dedicated to medical hair loss. It does not matter who you are, loosing your hair is a difficult process. We made this page to provide you a safe place to find the help you need and regain your confidence while you get through this transition. There may be options you do not know about, so please read carefully. Please reach out to us if you have any question. It is our honor to support you on this journey. 

 

Medical Wigs / Cranial Prothesis

Welcome to Cranial Prosthesis Medical Wig Insurance Coverage Guide provided by Hairy-God-Mother JoJo! If you’re purchasing a wig for medical purposes, this section is for you. Is there such a thing as medical wig insurance? Absolutely, but there are several steps to determine if you qualify. Also, your health insurance needs to offer this option. Let this page serve as a guide to medical wig insurance claims.

 

Does Health Insurance Cover The Cost Of Your Medical Wig?

The short answer is yes. If you are experiencing hair loss whether temporary or permanent. Unfortunately, not many people know this. But needing a wig due to hair loss caused by alopecia, chemotherapy, or other medical conditions, is covered by many insurances. And you can file an insurance claim for the full or partial cost of your cranial prosthesis.

 

What is a Cranial Prosthesis?

A cranial hair prosthesis is a custom hair system specifically designed 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.

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 allow one cranial prosthesis per year for medical hair loss. Additionally, you may also be able to deduct your prosthesis as a medical expense on your taxes. However, it has been confirmed that if medical bills exceed 7.5% of an individual’s income, then the wig is tax deductible. Still, it’s recommended though that you should discuss this with your CPA.

Unfortunately, in default policies, the Standard List of Exclusions prohibits coverage for wigs. Even so, you can ask your employer’s human resource department to renegotiate your contract to include your cranial prosthesis coverage. And if you have secondary insurance, you can contact your insurance broker to do the same.

Types of Hair Loss Covered By Insurance

• Hair Due to Chemotherapy
• Kidney Related Hair Loss
• 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

 

The Steps You Should Take

Contact the benefits department for your health insurance 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.

 

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. Remember, if your wig is tax deductible if your medical bills exceed 7.5% of your income.

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.

 

Insurance Companies and Cranial Prosthesis Coverage

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. Does not include cranial prosthesis.

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.

Information provided in this is based on U.S. Health Insurance Companies only. Information updated on August 20, 2021.