Insurance Coverage for Medical Wigs

Applying for Insurance Reimbursement:

• Check your benefits and covered expenses. Copy any page that specifically states that prosthetic devices (or medical treatments) are covered for alopecia areata or other types of hair loss.

• Include a Letter of Medical Necessity, Obtain a doctor’s letter or prescription stating the need for a hair prosthesis or treatment. Obtain a receipt that says ‘hair prosthesis’ from your wig vendor and has that person sign your insurance form.

• Include photos of yourself without a wig or corrective eye-makeup (pictures can also be used to emphasize why treatment is needed).

• Enclose a NAAF brochure describing alopecia areata.

• Provide a detailed personal account of the emotional effects of your alopecia areata (and discuss the costs of frequent hair prosthesis purchases).

• Ask your employer for a letter stating the importance of your general appearance, including your hair.

Insurance Denial Of Your Claim:

• Know your benefits and covered expenses. Obtain a copy of your full contract. Pay attention to exclusions for prosthetics (wigs may be excluded as cosmetic). If your policy does not spell out exclusions under prosthetics, this may help you win your claim. Educate yourself with your insurance company’s guidelines and deadlines for appeal.

• Understand why you were denied, so you can address the insurance company’s reason(s) directly. Involve your doctor in helping you respond to a denial. Speak with your plan administrator.

• Attach a copy of your original claim and all supporting materials. Know and explain the difference between a wig and a prosthesis. Explain the functions of body hair: it protects the scalp from the sun; protects eyes from dust particles; regulates body temperature; filters particles from the nose and protects the skin. If you are undergoing treatment, explain again how this is NOT cosmetic treatment.

• Ask for a written reply and carefully document all verbal conversations (insurance companies resist writing anything that may be considered ‘bad faith’ in future court cases).

• Send your appeal to a claims supervisor or manager. If you don’t, the person who initially reviewed your claim may reject it again.

• Consider contacting your state insurance commission, if you are unsuccessful with the appeal process. Keep all correspondence in preparation for this possibility.