If a person requires a "cranial hair prosthesis" while undergoing Alopecia or cancer-related therapy, they may be eligible for reimbursement under their health insurance plan?

If you need to wear a wig because of medical reasons like Alopecia and cancer-related therapy that the "wig" should be called a "cranial hair prosthesis" for insurance purposes?

If you file an insurance claim for reimbursement for a "wig" instead of a "cranial hair prosthesis" you will very likely be turned down?

Most insurance companies cover between 80 to 100% of a cranial prosthesis?

Insurance Companies are realizing your cranial hair prosthesis are more and more a necessity for those recovering from Alopecia and cancer treatments. 

Follow some simple guidelines to assure coverage, when it is available through your insurance company. 

Your physician should be able to supply all the details and make the referral for the purchase of your "hair prosthesis". Ask your physician to do that. 

When receiving your hair prosthesis, have your stylist complete an invoice for a "cranial hair prosthesis" NOT a wig and use the following   guidelines for filing an insurance claim.

• Check the benefits of your insurance. There should be a section under "covered expenses" relating to prostheses, prosthetic devices or medical durable equipment. Most companies don't spell out exclusions so pay attention to the actual coverage. this will help your case.
• Make sure to complete the insurance form and have it signed by your physician.
• Request that your physician write a "prescription" for a "full cranial prosthesis" (not a wig) and a letter explaining hair loss and its effects. That it isn't just for cosmetic reasons but for emotional well-being as well.
• Keep copies of your sales or invoices for your cranial prosthesis. (Portions of unpaid items by insurance are tax deductible.)
• Enclose a letter to the insurance company stating the necessity of a prosthesis.
• Some optional suggestions are

  - include a letter from your employer,
  - take pictures of yourself without hair,
  - hand write a letter detailing the emotional effects that your condition has had on your life,
  - bring a copy of your prescription and paid bill tot he American Cancer Society for partial reimbursement.

• If your insurance coverage is denied, you can appeal it:

            a. ask for review by a medical review board, include the original claim
            b. ask for a written reply as to why the claim was denied.
            c. send a letter tot he claims department supervisor.

These steps are for reference. Remember to follow the procedures outlined by your insurance company to receive the fullest benefits possible. Most companies cover between 80 to 100%. Individual insurance companies as well as the state insurance board (each state varies) may have other or additional steps to complete.

If you don't have insurance contact your state or county agencies. The county department of social services offers medical assistance in most states for individuals who meet certain income guidelines. 

1. What is a Cranial Prosthesis             

1. What is a Cranial Prosthesis

1. A Cranial Hair Prosthesis is medical insurance jargon for a hair system for those suffering from hair loss due to medical conditions. Prostheses contain a combination of fabrics and compounds that are used to re-create natural hair growth patterns and the look of the scalp. All materials in the prosthesis are designed to provide maximum comfort.

Cranial hair prosthesis are different from budget or department store wigs in quality. performance, and service. Prostheses are made of specialized material - sensitive to the needs of the individual. The fit is adjustable to each person's size and also custom cut and styled. A department store wig (budget wig) has a set style - what you see is what you get. Service plays an important role when selecting a hair prosthesis.

When looking for hair loss options, you need to decide what will best fit your needs - wigs, hats or turbans, integration hair pieces, hair replacements, or a custom wig.

A Medical Specialist can help you decide    

          
As each company has the option to determine what it will or will not cover with respect to durable medical equipment. You will need to review each company's policy to know what it does cover. If you are purchasing this insurance as a private individual, you could ask for a rider to be put on the policy specifically covering cranial prosthesis; however, you may be required to wait a length of time as the need is due to a pre-existing condition. If you are choosing this insurance as a benefit from your employer, chances are it is not covered by either of the companies you have mentioned as Alopecia is considered an "orphan" disease due to the few people per total population afflicted. Those of us, like me and you, who are afflicted do not see the difference between an ocular prosthesis, which does not provide a biological function, and a cranial prosthesis, which also does not provide a biological function, although most insurance companies will cover glass eyes.

Take heart in knowing there are people who are putting pressure on insurance companies to cover the cost of a cranial prosthesis, and you can always write to your congressman, senator and state insurance commissioner about your needs.