Insurance Coverage For Your Cranial Prosthesis

Did You Know that If a person requires a "cranial hair prosthesis" while
undergoing alopecia or cancer-related therapy may be eligible for reimbursement
under their health insurance plan? Insurance Companies are realizing more and
more that a cranial hair prosthesis is necessity for those recovering from
alopecia and cancer treatments.

If you need to wear a wig because of medical reasons like alopecia or cancer-
related therapy then the "wig" should be called a "cranial hair prosthesis"
particularly 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 hair prosthesis.

Guidelines for Filing Initial lnsurance Claims:

1. Most insurance policies cover "Prescribed Cranial Prosthesis" but do not
cover wigs.
2. Insurance companies cover the cost under procedure codes S8095 and
A9282
3. Get a letter and/or prescription from your doctor.
4. Make sure that the letter or prescription is for "Prescribed Cranial
Prosthesis"
5. It should not say wig-if it does, have it redone, otherwise your claim will most
likely be refused.
6. Have a receipt from the company you purchased the Cranial Prosthesis.
Make sure it says "Prescribed Cranial Prosthesis."
7. Have the physician sign off on the insurance claim form.

Waiting for your claim to be processed - prepare yourself for having your claim
denied
:

1. Know your rights as the insured party.
2. Obtain a copy of your FULL contract with your carrier (most people only
have a "Summary of Benefits" provided by the employer).
3. Read and know your contract.
A. Pay attention to the "exclusions" Wigs are excluded for cosmetics
reasons.
B. Pay special attention to Prosthesis coverage. Most policies do not spell
out exclusions under Prosthesis, and this is how you are likely to have your claim
accepted.

Submitting your appeal - (after denial of claim as not a covered benefit)

I. Write asking for a review by the Medical Review Board.
2. Attach copy of original claims.
3. In your letter, inform them of the difference between a wig and Prosthesis. (A wig is a fashion item and not a necessity. Prosthesis is a necessity, comparable to plastic surgery for a burn victim).
4. Ask for a written reply. (Companies try to avoid putting anything in writing).
5. Address your letter to a supervisor in the Claim Department.

Some other optional suggestions are:

a. Include a letter from your employer,
b. Take pictures of yourself without hair,
c. Hand write a letter detailing the emotional effects that your condition
has had on your life

Keep copies of your sales invoice(s) for your cranial prosthesis as your full
cranial prosthesis may also be a tax deductible medical expense.
These steps are just for your reference. Remember to follow the procedures
outlined by your insurance company to receive the maximum benefit possible.

Grants/Other Helpful Information:

If you don't have insurance you could try to 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.

Applying for a Grant or Voucher to Cover your Full Cranial Prosthesis (full lace
wigs): American Cancer Society has a program available to those who qualify to
assist you in purchasing a wig. If your insurance does not cover the full cost of
your wig or only covers partial cost of your wig, you may quality for an allotment
through the American Cancer Society.

The American Cancer Society will issue you a voucher up to $75 to help cover
the cost of your wig. You must meet certain financial guidelines. You MUST
apply for this voucher BEFORE you purchase a wig. It will not be awarded for
purchases made in advance. To inquire about getting financial assistance for
your wig purchase, you can contact the American Cancer Society at 1-800-227-
2345. Ask to speak to a representative in regards to: Financial Assistance for a
Wig Purchase.

The National Alopecia Areata Foundation (NAAF): NAAF has established the
Ascot Fund. This special pre-purchase program provides financial assistance
toward the purchase of a hairpiece to individuals who have alopecia areata and
are struggling financially. To find out if you qualify, please contact them at: E-
mail: info©naaf.org Web site: http://www.naaf.org/