Cranial Hair Prosthesis

What to do first

Most insurance companies will pay a percentage or the full amount for a cranial hair prosthesis (a wig) for anyone suffering from medical hair loss. The first step you should take is to call your insurance company and check to see what your coverage provides. It’s very important when discussing this topic with your insurance company to use term “cranial hair prosthesis” or “cranial prosthesis,” and NOT the word ‘wig.’ The reason for this is because a wig would normally be categorized as a cosmetic product which typically isn’t covered by insurance. While calling your insurance company, also ask them if they need a prescription from a specific doctor like your oncologist and/or dermatologist.

Getting a prescription and letter from your doctor

  • In the prescription, ensure your doctor use the terms “cranial prosthesis” and NOT wig.
  • In addition to your prescription, make sure to have your doctor write a letter detailing the extent of the hair loss, and the emotional and mental distress you’ve experienced due to your medical treatment.
  • Have your doctor state the reasons why they’ve prescribed a cranial prosthesis, how this is part of your treatment, and how it’ll benefit your recovery. Make sure they DO NOT use the word ‘wig’ or ‘wigs’ in the letter anywhere.
  • Have your doctor mention why the cranial prosthesis is a Durable Medical Equipment (DME).
  • Your insurance may also request a National Provider Identifier (NPI) code. You’ll be able to get this from your doctor to put on your claim file.
  • Your insurance company may also need Healthcare Common Procedure Coding Systems (HCPCS) codes: S8095 and A9282.

For medical hair loss such as alopecia, the word ‘alopecia’ alone doesn’t describe the diagnose. Make sure your doctor specifically notation on your prescription what type of alopecia it is (Alopecia Totalis, Alopecia Areata, or Alopecia Universalis). If your hair loss is due to other conditions, be sure to have your doctor write specifically what it is in scientific terms.

Time to get your cranial prosthesis

We’ll provide you with a receipt for your cranial prosthesis with a valid taxpayer number. The invoice will use proper terminologies needed for this purpose. The word wig will be excluded from the receipt.

File your claim

Insurance companies most likely will have you buy the wig first and send in a claim. Be sure to ask them if they’d require any specific information. When filing your claim, insurance companies may also require the claim to be under Durable Medical Equipment (DME). Some common documents you’ll need,

  1. Doctor’s prescription
  2. Doctor’s letter
  3. Receipt for cranial prosthesis
  4. Completed claim form for your insurance company.

While submitting your claim to be processed, make sure to keep a paper trail and a copy of everything in case there’s a delay or something goes missing. Things such as your prescription, purchase receipt, a completed insurance submission form, and correspondence with the insurance company. Emails are great in this case.

Remember not every insurance company offers coverage and if they do, their procedure may vary from one to another. Please contact your insurance company for what their requirements are.