Guide to Cranial Prosthesis & Medical Insurance Coverage

A cranial prosthesis is a wig designed specifically for people suffering from hair loss due to medical conditions such as alopecia areata, alopecia totalis, trichotillomania, chemotherapy, thyroid- or kidney-related hair loss, or other genetic or clinical diseases or treatments resulting in total or partial baldness.

Because a cranial prosthesis is a medical device, full or partial coverage of the cost is available through many medical insurance companies. However, to get insurance coverage, you need to know what to ask for and how to ask for it.

Cranial Prosthesis Insurance Coverage

Depending on your policy, you may need to pay up-front and be reimbursed. Most insurance companies will cover between 80 and 100 percent of the cost of your cranial prosthesis and will allow you to receive one per year for medical hair loss. Wigs for cosmetic reasons are direct policy exclusions, so your doctor needs to indicate that the wig is for medical reasons.

Here’s how to go about getting coverage for your cranial prosthesis.

Call your insurance company and ask about coverage

First, do a little research. Get a copy of your full health insurance contract—not the summary you were given when you first got your benefits—and look specifically at the section about prosthesis coverage. Most policies do not spell out exclusions under prostheses, and by applying for prosthesis coverage, you are most likely to have your claim accepted.

Once you have that information, call the toll-free number on the back of your insurance card and ask if your policy covers a cranial prosthesis (not a wig!) and how much of the cost the policy will cover. If it is eligible for coverage, ask what type of prosthesis is covered—do they cover human hair wigs, or do they only cover synthetic wigs, for example? Ask if you need a pre-approval for coverage and what documentation is needed for that pre-approval. Finally, ask what specific documentation you will need when you file your claim.

Get a prescription from your doctor

Once you’ve determined whether your health insurance may cover the cost, ask your doctor to write a prescription for a cranial prosthesis, or the specific terminology required by your health insurance provider. Other terms insurance companies may use include hair prosthesis, hair prosthetic, and cranial prosthetic.

If you need to get a pre-approval, get a letter from your doctor explaining the effect your hair loss is having on you and have them state that the piece is not simply for cosmetic reasons but for your emotional well-being.

Make sure you have a paper trail

Make copies of all the paperwork and correspondence related to your cranial prosthesis and keep these papers organized and easily accessible.

At minimum, keep this information

It’s critical that you have your doctor’s prescription, the sales receipt for your cranial prosthesis, your completed insurance claim form, and any correspondence between you and the insurance company. This information could also be useful for other purposes including a tax deduction (more on that later).

Save time and aggravation

Insurance companies process thousands of claims every day, so paperwork can get lost during the claim process. Keeping a file with all your cranial prosthesis-related costs will make it easy to resubmit your claim if your original claim goes missing.

You can appeal a denial

If your insurance claim is denied, don’t give up. The denial will most likely be on the grounds that your cranial prosthesis is simply a wig, which is a cosmetic device rather than a medical one. Every insurance company has an appeals process, which you can use to address the reasons for the denial—and possibly get approved after all.

Other Ways to Cover the Cost of a Cranial Prosthesis

If your insurance company refuses to pay for your cranial prosthesis, there are other options to help you obtain one. Your prosthesis may be tax-deductible, for example, or you may be able to find resources through charity programs or support resources. 

Tax deduction

If you need to pay for your wig out of pocket, save your receipt in case the cost of a cranial prosthesis is tax-deductible. If your medical bills are more than 7.5 percent of your adjusted gross income, the cost of the wig could become tax-deductible. The IRS offers a tool that will help you determine if a medical or dental expense is tax-deductible.

Individual states may have lower adjusted gross income thresholds for deducting medical expenses. Check your state’s revenue service website or contact the agency by phone to get clarifications on deductible expenses.

Charity programs

The American Cancer Society, National Alopecia Areata Foundation, and other organizations advocating for people with medical hair loss have donation or cost coverage programs available. Check the internet for reputable websites about your illness or condition and see if they have programs to help you cover the cost of a cranial prosthesis.

Local or online support resources

Local support groups for your illness or condition may include people who have been through the process of buying a cranial prosthesis. Your doctor’s office or hospital may have links to support groups in your area. Online resources, whether forums or social media pages, can also be helpful.

While Jasmine Nicole does not work directly with insurance companies, we will be happy to provide you with any documentation you need to submit your claim.

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