Are Wigs Covered by Insurance? How to Get Reimbursed
Understand how insurance covers wigs for hair loss. Get expert guidance on navigating policies and securing reimbursement.
Navigating health insurance can feel complex, particularly when seeking coverage for items like wigs. While many might consider wigs to be purely cosmetic, certain medical circumstances can transform them into a necessary device for an individual’s well-being. Insurance coverage for wigs is not universal and largely depends on policy details and the medical context surrounding their need. Understanding these varying factors is key to determining potential reimbursement.
Medical Necessity and Wig Type
Insurance providers cover wigs only when medically necessary. This medical necessity arises from conditions causing significant hair loss, such as chemotherapy, various forms of alopecia, severe burns, or certain skin conditions affecting the scalp. For insurance purposes, a wig prescribed due to a medical condition is often called a “cranial prosthesis” or “hair prosthesis.”
A cranial prosthesis differs from a standard fashion wig. These medical wigs are custom-fitted to an individual’s scalp, often made from hypoallergenic materials to prevent irritation on sensitive skin. They are designed for extended wear, providing breathability and a secure fit that can withstand daily activities. This specialized construction helps restore a patient’s comfort and confidence during treatment or recovery.
Understanding Your Insurance Policy
Determining if your insurance policy covers a cranial prosthesis requires review of your policy documents. Coverage information is often found in sections related to durable medical equipment (DME), prosthetics, or other benefit categories. These sections outline what devices are covered, under what conditions, and any associated financial responsibilities.
Policies commonly feature provisions such as deductibles, which is the amount you must pay out-of-pocket before your insurance begins to cover costs. Co-insurance requires you to pay a percentage of the cost after your deductible is met, while out-of-pocket maximums cap the total amount you will pay in a policy period. Coverage limits might also specify a maximum reimbursement amount or frequency, such as allowing for one cranial prosthesis per year.
Private health insurance plans vary in coverage for cranial prostheses, with many recognizing them as medically necessary. Medicare does not cover wigs under Original Medicare Parts A and B. However, some Medicare Advantage (Part C) plans may provide coverage for wigs, particularly for hair loss due to chemotherapy. Medicaid programs also vary by state, with some offering coverage.
Contact your insurance provider directly to confirm benefits before making a purchase. Ask about “cranial prosthesis” coverage, required documentation, and any pre-authorization needs to prevent misunderstandings. Document these conversations, including dates and representative names, for future reference.
The Reimbursement Process
Once medical necessity is established and policy details are understood, the reimbursement process involves several steps. First, obtain a prescription or letter of medical necessity from a healthcare provider. This document should state the diagnosis, such as ICD-10 codes for alopecia areata or hair loss due to chemotherapy, and confirm the need for a “cranial prosthesis,” not a “wig.”
The prescription or letter should also include the physician’s National Provider Identifier (NPI) code and signature, along with any other details required by your insurer. When purchasing the cranial prosthesis, ensure the retailer provides an itemized receipt or invoice that lists the product as a “cranial prosthesis,” not a “wig.” This invoice should also include the retailer’s tax identification number and the Healthcare Common Procedure Coding System (HCPCS) code A9282.
After gathering all necessary documentation, including the prescription and any prior authorization approvals, complete your insurance company’s claim form. This form can be found on their online portal or requested directly. Submit the claim online, through a secure portal, or by mail.
Following submission, insurance companies process claims, which can take several weeks. You will receive an Explanation of Benefits (EOB) detailing what was covered, the amount reimbursed, and any remaining balance. If a claim is denied, policies outline an appeals process, allowing you to submit additional information or request a review of the decision.