Cranial Prosthesis: How to Get Insurance to Cover Your Medical Wig

First of All: What Exactly is a Cranial Prosthesis? 

A ‘cranial prosthesis’, often referred to as a ‘hair prosthesis’, is a wig specifically designed for individuals who have lost their hair due to medical conditions or treatments such as alopecia areata, alopecia totalis, trichotillomania, chemotherapy, or other medical causes. The term "cranial prosthesis" is used in medical and insurance contexts to differentiate these wigs from fashion wigs and to ensure coverage under medical insurance or eligibility for tax deductions.

Cranial prostheses are not new—doctors have been prescribing them since the 1950s. These medical wigs help not only with appearance but also protect patients with compromised immune systems from harmful UV rays and help regulate body temperature.

Why Should You Use the Term 'Cranial Prosthesis' and Not 'Wig'? 

When applying to your insurance company for reimbursement or payment, it is crucial to use the term ‘cranial prosthesis’  rather than "wig." Insurance providers are more likely to cover the cost of cranial prostheses as they are considered medical devices rather than cosmetic accessories.

Will My Health Insurance Cover a Cranial Prosthesis? 

**The short answer: Yes, but it depends on your insurance company and plan.** 

Many health insurance companies in the United States, including **Blue Cross Blue Shield (BCBS), Cigna, Aetna, and others**, provide coverage for cranial prostheses, either partially or in full. The amount they will reimburse depends on your insurance policy. Some plans cover the full cost, while others may reimburse you for a portion of it.

 However, to qualify, you need a medical diagnosis that makes the cranial prosthesis a **medical necessity**. This includes conditions such as **cancer, alopecia, trichotillomania, or any treatment-related hair loss**. 

When seeking coverage, it's essential to:

1. Contact your insurance provider to determine if your plan covers cranial prostheses and to what extent.
2. Obtain a **prescription or letter** from your doctor that specifically states "cranial prosthesis" as a medical necessity.

Important: Use the Correct CPT Code 

To submit a claim to your insurance company, use **CPT Code A9282** for cranial prostheses. This code is recognized by many insurance companies and will help ensure your claim is processed accurately. 

Can I Use My FSA or HSA to Pay for a Cranial Prosthesis? 

Yes, in most cases, you can use your Flexible Spending Account (FSA) or Health Savings Account (HSA) to cover the cost of a cranial prosthesis. However, similar to insurance claims, you'll need a ‘letter of medical necessity’ from your doctor stating that a cranial prosthesis is required for your condition. 

Once you have purchased your cranial prosthesis, you can submit the receipt along with your doctor’s letter to your FSA or HSA provider for reimbursement.

Quick Tip: Using Your FSA/HSA for Other Medical Necessities

Your FSA or HSA can be used for a range of medical treatments beyond wigs. For example, some people use these accounts for physical therapy or even massage therapy when prescribed by a doctor.

What Conditions May Qualify for Coverage? 

Insurance companies may cover cranial prostheses for hair loss caused by medical conditions such as:

• Cancer treatments (chemotherapy or radiation)
• Alopecia (areata, totalis, or universalis)
• Hypothyroidism
• Trichotillomania
• Kidney disease
• Severe stress or trauma
• Side effects of medication

Hair loss due to lifestyle factors, such as aging or environmental stress, may not always qualify for coverage. It’s best to confirm your specific condition with your insurance provider.

What Should You Do Next? 

Here’s a simple step-by-step guide to navigate the process of securing coverage for your cranial prosthesis:

1. Contact your insurance provider: Call, email, or chat with your insurance company to confirm if cranial prostheses are covered under your plan. Ask them about the percentage they cover and what forms are needed for reimbursement.

2. Get a prescription or letter: Request a prescription or letter from your doctor, and ensure that the term cranial prosthesis is included to increase the likelihood of insurance coverage.

3. Contact your FSA or HSA provider: If you plan to use your FSA or HSA, reach out to your provider and ask what documentation is required. Typically, a doctor's note stating the medical necessity of the cranial prosthesis is sufficient.

4. Shop for your cranial prosthesis: Head over to our shop and select the perfect wig for your needs. If you don’t see what you’re looking for, feel free to call or message us for personalized assistance!

5. Request an insurance-friendly invoice: Once you’ve made your purchase, let us know if you need a special invoice for your insurance company, and we’ll provide one.

By following these steps and ensuring you use the correct terminology and CPT code  A9282, you’ll have a much smoother experience securing reimbursement for your cranial prosthesis.