I am looking for advice on insurance coverage for wigs.  My daugther is 16 and has had alopecia for 13 years.  My insurance company only gave me $1500.00 for a lifetime.  I am very frustrated with the fact that insurance companies don't help children and adults with the cost of wigs.  Has anyone fought for coverage and won? If yes, any advice you have would be grealy appreciated.  I live in New York. 

Thank you!

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Hi Alipack,

 Have you considered using a HSA (Health Savings Account) for coverage?  You might get better coverage since the benefits accrue yearly and can be used for  unreimbursed medical expenses. Your daughter would most likely need a prescription for a wig to be covered by the HSA.  Typically a wig would not be covered but a cranial prosthesis (or whatever the required medical terminology or DX code is) likely would be. The HR department at your place of employment should be able to help you navigate the details and requirements. 

I hope that helps.  Happy New Year! :-)

Thank you for your response!  I have gotten a prescription before so that's not a problem.  It's just that my health insurance plans refuses to give me any assistance since they believe this is "cosmetic".  Isn't a HSA a savings plan? I'm sure it would definitely help if this is the case; however, unfortunately, I don't have additional funds to set aside (very limited) which is why I am looking for advice to get remibursed from insurance.  

Yes, a HSA is a type of savings plan. The nice thing is that the money isn't taxed so it gives you more money to work with.  It comes directly out of your paycheck.  

I'm wondering if it is the way the prescription was written is why your insurance company considers it cosmetic?  I have never seen an insurance company cover a wig, but some companies will cover a "cranial prosthesis" or a "full cranial prosthesis"

Have you tried appealing your insurance company's decision regarding coverage?  It can be a difficult and lengthy process but worthwhile if they offer additional coverage.  $1500 for a lifetime doesn't give you much to work with. :-( 

Have you considered exploring other insurance plans during open enrollment?  You might find a plan that offers better coverage.  

You might request from your current plan a list of providers that accept your insurance for wigs.  The provider/s may have additional information and resources that can help you.  The provider/s might be aware of organizations that assist children/teens who need a wig, or they may have options they can offer to assist you.


Thank you so much for the reply and information.

The Empire Plan has a policy regarding a $1,500 lifetime benefit cap when hair loss is long term and due to a medical condition. The letter they sent me notes that the Affordable Care Act regulations specify that there may not be a dollar maximum for services classified as an Essential Health Benefit. Unfortunately, wigs are not classified as an Essential Health Benefit and, as a result, Empire feels it is appropriate for them have a lifetime benefit maximum for prosthetic wigs.  Even with the prescription.

Thank you again for the information and have a great day.

I have an HRA through my husband's union that can reimburse for my "hair" (I wear synthetic & usually get @ 6mos of daily wear from them). As long as you have a written diagnosis, an physicians order for a cranial prosthesis, you can deduct 100% of the cost from your taxes as a medical expense(:

"Cosmetic"???  Insurance companies have always covered cosmetic problems if they were due to illness, disease, injury, accident or birth defects.  Also, several years ago my insurance company refused coverage for a wig because they said it was "not medically necessary" (Highmark Insurance Co.).  Yet, they admitted in the same denial letter that they cover wigs for cancer patients!  What the h@ll!!!  I called the company and asked how they define "medically necessary".  They could not.  I also asked why they cover a wig for one illness and not another illness.  Again, they could answer that question.  We have a REAL disease--an autoimmune disease!  The discrimination against alopecia areata patients has to stop!!  We need to fight this one.

We're a NYC based provider for units, I am a bit unclear on the 1500 for lifetime; your daughter would need an ongoing allowance as long as you have a prescription and refferal for a " In netowrk" provder you should be have more coeverage, I will look into this more and get right back to ya

In Connecticut a few years ago, I got only about $350. That was the amount they had to give, as I guess that’s what an off the shelf wig costs.

i was kind of happy to get that, to be honest. My dermatologist (who I knew socially before he became my dermatologist) filled out the forms exactly right.  I guess my feeling is that while wigs aren’t just cosmetic (but that is obviously a major component), the insurance company doesn’t have to pay for the greatest wigs either, just like they don’t have to pay for brand drugs if generics are available. I paid a lot more for mine and was willing obviously. 





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