How to Advocate with Your Insurance Company for Medical Wig Coverage
By Bria Midgette
Cicatricial, or scarring, alopecia is an inflammatory condition in which the hair follicles are destroyed and replaced by fibrous tissue resulting in permanent hair loss. Scarring alopecia is commonly caused by factors that increase inflammation such as hair relaxers and other chemicals, repeated pulling on hair (e.g. tight hairstyles), inflammatory disorders, burns, radiation, or infection. Although the damage to the follicle is generally irreversible, treatment is most effective during the early stages of the disease and can potentially reverse the condition. Depending on the severity of the inflammation and scarring, a variety of medical and surgical treatment options exist. Despite the numerous options available, treating scarring alopecia can be difficult and the permanent hair loss can have a profound psychological impact. While battling the condition, many make the personal decision to wear wigs, toppers, and other hair pieces to conceal their hair loss. Although this is a common decision, several challenges may arise relating to cost and coverage.
Wigs and hair pieces are great options for patients with scarring hair loss, but they can be expensive. Cicatricial alopecia is a medical condition; therefore, many insurance companies are willing to cover all or part of the cost of items relating to the burden of the disease, including hair pieces. After you have made the decision to wear a hair piece or wig, it is important to research what your insurance plan may cover. Begin with reaching out to your health insurance company directly, preferably by phone. Gather and organize any supporting documents you may need, such as medical records or lab results, to prepare for this conversation. If you have purchased a hair piece without using your health insurance, it is important to keep receipts for potential reimbursement. Some important questions to ask once you get in contact with a insurance representative are: “What is covered by my insurance plan for alopecia?”, “How much of the cost is covered by insurance?”, “Am I eligible for reimbursement if I have already made a purchase?” Understanding the medical terminology required by your insurance company can help facilitate this process. Many insurance companies use the term “cranial prosthesis” to define wigs relating to chemo-related hair loss, thyroid-related hair loss, alopecia, and other hair disorders. Terminology is important because while a “cranial prosthesis” may not be covered, a hair piece can fall under another covered category such as medical equipment.
When advocating for yourself with an insurance company, it is essential to collaborate with your physician and provide full transparency on your financial situation. While gathering information from your insurance company, explain to your doctor what your insurance company covers so they can find ways to help get the wig or hair piece covered under one of those categories. Your doctor will also need to ensure that they have the correct diagnosis code to qualify for a medical wig. Your doctor can continue to advocate for you by writing letters to the insurance company explaining why these items should be covered for your condition.
If you have tried these options and your health insurance company still refuses to aid in covering the cost of your hair piece, you can file a claim. Other alternatives include connecting with social workers, support groups, or organizations to search for programs that provide either financial assistance or the option to receive a wig as a donation. Advocating for yourself can be a difficult process, but it can truly be empowering! Take pride in knowing that you are working to make change and help others by bringing awareness to scarring alopecia and the struggles those with hair loss may face.