Living with alopecia areata can be challenging, both emotionally and financially. Sudden hair loss can be difficult, so it’s vital to find ways to cope. Many people with alopecia areata choose to wear a wig. More and more, some health insurers recognize wigs as medically necessary for those with alopecia areata, which means they may reimburse some of the cost. Points to Consider Unlike most medical procedures in the U.S., wig costs must be prepaid. Patients then submit a claim to their insurance company, and the insurer decides how much, if anything, to reimburse them. There is no guarantee that your insurance company will reimburse you for the cost of your wig. Your insurer may deny your claim, or the company may only reimburse a portion of your costs. Choose a price point for your wig that makes sense for your budget, knowing you may not be fully reimbursed. Table of Contents: Step 1: Think like a health insurance provider Step 2: Understand your policy Step 3: Get a diagnosis and a prescription Step 4: Work with your wig supplier Step 5: Submit your claim Appealing denials Exploring alternative funding FAQs Resources Here’s a step-by-step guide to help you advocate for the coverage you deserve as you navigate the reimbursement process. Step 1: Think like a health insurance provider. For years, most health insurers deemed wigs a cosmetic item, so they did not cover them as a medical necessity. The first step is to think like an insurer and use terms that comply with your policy. That means when speaking to your physician or insurer, always use the term “cranial prosthesis” (medical wig) and not “wig.” Step 2: Understand your policy. Before buying a cranial prosthesis, call your insurer and ask if your policy covers it. When you talk with your insurer, tell them you have alopecia areata, a chronic autoimmune disease. Many insurance policies won’t list coverage for a cranial prosthesis in literature or on their website, so, it’s best to call and ask about your policy. (If your health insurance is through your employer, your Human Resources Benefits Manager might also be able to help.) You’ll want to ask: Do I have coverage for a cranial prosthesis? How many cranial prostheses can I receive reimbursement for each year? (Some companies may reimburse for more than one per year.) What is the most that insurance will reimburse for each cranial prosthesis? Do I need specifics about the prosthesis for reimbursement? For example, is customization or a certain type of cap (medical grade) required? Are there “in-network” retailers for purchasing a wig? (Buying in-network may maximize your benefit.) What is the specific process to submit a claim for reimbursement? Step 3: Get a diagnosis and a prescription. To qualify for reimbursement, you’ll need documentation from your healthcare professional. Schedule an appointment with your dermatologist or specialist. They can confirm your diagnosis of alopecia areata and provide a letter (or prescription). It will state your condition and the recommended treatment: a cranial prosthesis. The letter or prescription should also include: Diagnosis code – a medical code for alopecia areata (or its specific type). As of October 2024, the ICD codes for alopecia areata are as follows: L63.0 – Alopecia totalis L63.1 – Alopecia universalis L63.2 – Ophiasis L63.8 – Other alopecia areata L63.9 – Alopecia areata, unspecified NPI Code – a unique identification number for the healthcare provider The physician’s signature Any other specifics from your physician that your insurance company requires Step 4: Work with your wig supplier/retailer. Before you buy your wig, ask your retailer if they can provide a medical invoice, which you will need for your claim. If your insurer requires using a preferred vendor, choose from them. Your cranial prosthesis receipt (or invoice) from the retailer should include: The product you are purchasing, listed as a “Cranial Prosthesis,” not a “wig.” Include the price and any customization fees. The retailer’s Tax ID # HCPCS code – a medical code for cranial prosthesis. (As of October 2024, it is A0282.) NPI code – a unique ID number for covered cranial prosthesis providers. Not all retailers will have this. If your retailer does not, proceed without this code. When selecting a wig, keep in mind that the type of wig may impact reimbursement. Some insurers prefer medical-grade wigs designed specifically for those with medical hair loss. (Clarify this with your insurer when inquiring about your coverage.) Step 5: Submit your claim. First, be sure to prepare the necessary paperwork to submit your claim. This will include: The diagnosis letter: A letter or prescription from your healthcare provider. It must confirm your diagnosis and need for a cranial prosthesis. Receipts: Keep all receipts and invoices related to your wig purchase. Insurance Claim Form: Get and complete the claim form from your insurer. Other documentation: Some insurers may request more documentation, such as before-and-after photos of your hair loss. Once you have all your documentation: Contact your insurer: Call your insurance provider before submitting. Confirm which documents you need and clarify any questions. Submit your claim: Use your insurer’s recommended method to send your claim form and all documents. This includes their online portal, email, or mail. Follow up: Contact your health insurer two to three weeks after submitting your claim. This ensures that they received it and that you included all the required info. Track: Keep a running log of all conversations with your health insurance provider. Include the date and method of communication, name of representative, reference numbers, additional documents sent (and the method), and any other pertinent information. Use this log as a reference guide when speaking with your insurance provider. Continue to follow up with them regularly until you receive word that the claim was approved or denied. Appealing Denials What happens if they deny my claim? If the insurer denies your claim, don’t lose hope. You can (and should!) appeal the decision. First, review the denial to understand the reasons for the denial of your claim. Was the claim filed correctly? Was the claim filed for a cranial prosthesis? Does your insurance company understand this is for a medical need, not a “cosmetic”? Did you attach all your documents to the claim? Are there missing codes? Does your insurance company need more information from your retailer? Tax ID? Address? W-9 Form? Is more information needed from your doctor? Gather more documents or a more compelling letter from your healthcare provider if needed. If all documents are correct, follow your insurer’s appeal process, and provide all necessary information. Exploring alternative funding If your insurance does not cover wigs, consider other options: Health Savings Accounts (HSAs): If you have an HSA, you may be able to use those funds for your wig purchase. Community Support: Local groups or online communities can offer resources and funding. Nonprofit Organizations: Some groups fund wigs for individuals with alopecia areata or other conditions. These include: Wigs for Kids Locks of Love Hair We Share Children with Hair Loss Wig reimbursement from health insurance can be complex. But with the right approach, you can get the support you need. Document in detail, conduct regular follow-ups, and seek help when necessary. FAQs Will my insurance company cover the cost of my wig? Every insurance policy differs, but more companies are reimbursing for wigs. Your best bet is to check with your insurer directly before making any purchases. What is a cranial prosthesis? A cranial prosthesis is a medical term for a wig. When you talk to your insurer, always use “cranial prosthesis” (not “wig”). Insurers may consider wigs as “cosmetic,” which are not covered. Resources Five Steps to Getting Your Wig Costs Reimbursed by Your Health Insurer (downloadable PDF) Webinar: Wigs and Insurance: How to Advocate for the Coverage You Deserve NAAF thanks our community member Supriya Surender for sharing her own experience and knowledge in the above webinar and in the content on this page.
