Health insurance companies vary in their willingness to cover or contribute toward a medically necessary wig. Medical reasons for needing a wig or hairpiece include long-term and short-term hair loss, such as chemotherapy, alopecia areata and trichotillomania. It is wise to contact them before you make your wig selection as their policy could affect your choice. Regardless of the extent of coverage, most require that your wig is purchased first and then the receipt is submitted by you to your health insurance company.  If you need a wig due to medical hair loss, please notify me and you will be provided a receipt that says, “cranial prosthesis” and has the necessary provider ID numbers to submit to your insurance company.

The term cranial prosthesis (a wig for medical patients who have hair loss due to a clinical disease) is used when applying for medical insurance, tax deduction status or HSA or FSA coverage. Other common terms for a wig used for medical purposes include: full cranial prosthesis, hair prosthesis and scalp prosthesis. The terms are used interchangeably by medical professionals and health insurance companies but it’s helpful to know them all.

In addition to possible insurance coverage, your prosthesis may also be a tax-deductible medical expense. If a person's medical bills are over 7.5% of their income, then the wig would become tax deductible. Cranial prostheses are covered under health FSAs and HSAs as well. 

Questions for your health insurance provider: 

• Does your policy cover a cranial prosthesis? 

• If yes, what type of cranial prosthesis is covered (i.e. synthetic wigs, human hair wigs, etc.)? 

• How much of the cost will you cover? 

• What specific terminology do you need to have on the prescription for a wig? 

• What specific documentation do you need to process your claim? 

Note: If you are reviewing your insurance policy and do not see cranial prosthesis listed, this does not automatically mean that you don’t have coverage. We highly recommend calling your Health Insurance Provider and getting pre-authorization. 

Then request and obtain a prescription for a “cranial prosthesis” (or the specific terminology required by you Health Insurance Provider – NOT the word “wig”) from your doctor or physician including the diagnosis code and procedure code A9282 (this is the wig code). The health insurance company requires both. 

To support your claim, consider asking your physician to write a letter explaining hair loss and its effects and have them state that it is not simply for cosmetic reasons but for emotional well being. 

Keep copies of all of your documentation and invoices from your physician for tax exemption (and possible appeal) purposes. 

Send all documentation (your doctor’s prescription, copy of your receipt from My Wig Coach, completed insurance claim form, and any other necessary forms) to your Health Insurance Provider. 

If your insurance won't help cover the cost of your wig: 

If your initial claim is rejected, submit an appeal. Do not take this rejection as a sign that they are right and you are wrong. Write a letter requesting a review by the medical review board of your insurance company, and request a written reply. Include a copy of your original claim and a photo of yourself without the cranial prosthesis. We have seen this be successful. Send your letter to a supervisor in the claims department. That way, your claim will most likely be reviewed by a new person.

A final word about the claims process: There’s no question that this process can be frustrating at times, however, try not to let it upset you. Insurance companies are huge bureaucratic machines, processing thousands of claims each day just like yours. Anticipate delays as far as paperwork is concerned. Sometimes you’ll receive a rejection before one of your appeals has been processed. Do not take any of it personally. Be the squeaky wheel, remain persistent, and keep an accurate log of all transactions. 

When paying for your wig out of pocket, save the receipt just in case your purchase qualifies as a tax deduction. If a person's medical bills are over 7.5% of their income, then the wig would become tax deductible. Check with your tax advisor.  Your state may reimburse you for the sales tax on your wig, check with your state’s sales tax department. In NY, the form required is Form AU-11 and the same documentation provided to the insurance company should be provided with this form.

Talk with your doctor or social worker about local resources. Contact your local chapter of the American Cancer Society, National Alopecia Areata Foundation (NAAF), and other foundations about qualifying for financial assistance toward the purchase of a hair piece or wig. Some wig salons offer gently-used donations to those in need. My Wig Coach has several styles and colors at reduced prices.