A hair prosthesis (or cranial prosthesis) is a custom-made wig specifically designed for clients who have lost their hair as a result of medical conditions or treatments, such as alopecia areata, alopecia totalis, trichotillomania, chemotherapy, or any other clinical disease or treatment resulting in hair loss. But how does it differ from a wig, you may ask. People often use these terms interchangeably, but they are truly different. Basically, a wig is worn for cosmetic reasons, while cranial prosthesis are primarily used by people with health issues related to hair loss. Additionally, cranial prosthesis are made more in detail than wigs. Each prosthetic is custom made to fit the shape of the patient's head. Cranial prosthesis also features materials that are custom designed to be comfortable for the clients head.
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Common Questions About Insurance
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 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
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.
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.
Add a personal touch. By having your doctor write a letter, you become more human, and not just a claimant. In the letter, your doctor can explain hair loss and its devastating effects on a recipient. Also, he/she can state that your prosthesis is not for cosmetic reasons, but for your emotional well-being.
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 CranialProsthesis.net or over the phone at (985) 224-5355.
After placing your order with CranialProsthesis.net, email firstname.lastname@example.org with your order number. Let us know that you need a copy of your invoice for your cranial prosthesis prescription.
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 CranialProsthesis.net, 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. 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 qualify 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.
Reimbursement rate for participating providers of wigs (cranial prosthesis) diagnosis code A9282 is $1,000.
You will need a prescription from your physician with the diagnosis code A9282 for a cranial prosthesis to qualify for a medical wig.
Because Medicare considers wigs to be cosmetic, they aren’t covered under Original Medicare Part A or B, even with a doctor’s prescription.
Coverage for wigs, hair prosthesis is excluded unless specifically listed as a covered health care service.