For the last two years I've successfully received reimbursement for my wig once a year for $350. It's always been a fight, the first time I had my states attorneys office step in, the second time I was able to do it on my own even after the claim was initially denied. This time I am completely unsuccessful. I contacted the states attorneys office a while back but never got a response. Now I was just told that my claim would not be granted because it is "cosmetic". Which is BS on its own because they previously denied me because I had the wrong diagnosis code, I gave them the correct one and now it's denied because they don't cover this comesmetic claim, I could care less about being reimbursed at this point, but it's about the principle. I happen to live in a state that requires reimbursement for at least $350 a year and includes alopecia areata as a reimbursable claim. Unless I'm reading this statute wrong, I'm right. I'm so frustrated and I don't know what to do about fighting this last denial of my claim. Any suggestions?

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Comment by George on March 27, 2018 at 10:46pm

It depends on your state.

I was personal friends with my dermatologist before he was my dermatologist.  The last time I got a new wig, I asked him about it, and he filled out some prescription firm with some very specific code.  I sent it in to the insurance company and got a check a few weeks later.

I am in Connecticut, which has pretty strict rules about this, but it still required filling out the prescription form exactly right.  The code you use will depend on the state.

Comment by Joe S. on March 27, 2018 at 11:16pm

I think that is the way to do it. Some kind of prescription either from a dermatologist or a psychiatrist  

Comment by Cindie on March 28, 2018 at 6:22am

Twenty years ago, Pennsylvania insurers (at least mine at the time) covered wigs.  Then they stopped.  We had a state legislator introduce a bill in the House of Representatives that would force them to do so, but that legislation went nowhere.

Comment by andrea t on March 28, 2018 at 8:27am

Alopecia is a medical diagnosis and has a "symptom"--hair loss. I have conflicting  thoughts about wig coverage/reimbursement and am trying to figure out where I stand. Some questions come to mind. Should eyebrow tattooing also be covered? Is it equivalent to corrective eye glasses?Are they covered? Are hearing aids?

A wig can help emotionally and socially, but is it a medical necessity, or a social one? It definitely is a psychological one.

I have alopecia, so don't get me wrong, this is not a judgmental diatribe. I'm just thinking about comparisons, equivalents, social pressure, expenditures, and so forth. Is it like a like a rhinoplasty (which isn't covered unless you have a deviated septum or other medical issue, etc.), or more like a acne, both of which have social as well self-esteem consequences. Acne medicine is covered.

Anyway, your frustration is understandable, especially since your state has legal reimbursement. Aside from the philosophical/social aspects of hair loss, I think fighting for your right to get reimbursed as written into the law, is important. Baldness is capricious enough without adding bureaucratic arbitrariness to the mix.

At an alopecia support group meeting I attended, a female alopecian minister said she felt it would be inappropriate to not wear a wig in front of her congregation. I found that odd (the "inappropriate" part, that is, because she is religious so where does "shame" come in for a medical diagnosis?) but is that justification for wig reimbursement?

Anyway, I wouldn't leave the house if not for my wig, but I also feel I would be better off if I did. I also think the wave of plastic surgery So, to my mind, intertwined in this issue is 

Comment by Sherry Schaefer on March 28, 2018 at 9:19am

How frustrating.  I deal with this all the time.  I assume you're referring to your wig as either a "cranial" or "scalp" prosthesis.  That's critical, as is including a prescription (script) from your doctor, either your GP or dermatologist.  If denied, 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. (I have seen this be successful.)   Send this letter to a supervisor (get a name) in the claims department.  That way, your claim will most likely be reviewed by a new person.  Good luck!

Comment by Miki817 on March 28, 2018 at 10:20am

From your post I presume you mean standard coverage.  I'm not sure about that but I have been successfully receiving reimbursement from my FSA and HSA accounts (FSA at one job,  HSA at another).

Wigs are eligible for reimbursement with flexible spending accounts (FSA), health savings accounts (HSA), and health reimbursement accounts (HRA) with a Letter of Medical Necessity. (The "necessity" for it being stated as coping with the psychological effects with an illness which makes it no longer cosmetic.) They are not eligible for reimbursement with dependent care flexible spending accounts and limited care flexible spending accounts (LCFSA).

Comment by SabineTawni on March 28, 2018 at 10:39am

So happy to hear, Jessica!  A wig for alopecia areata is "cosmetic"??  Insurance companies have ALWAYS covered "cosmetic" issues if they were caused by illness, disease, injury, birth defects, and accidents.  When did that change?  If it changed, it should not have because the change was only implemented to help insurance companies make a profit.  We have a REAL DISEASE--an autoimmune disease.  If insurance companies pay to treat vitiligo, psoriasis, eczema, how can they justify discriminating against our autoimmune disease?  We cannot let them get away with this!  Again, I commend you, Jessica, for pursuing this cause.

 

Comment by hagster on March 28, 2018 at 11:45am

Medicare considers a wig as 'durable medical equipment' and lumps it in with masectomy prosthesis and bras,  and ostomy supplies.  However, they will not cover a wig / cranial prosthesis unless one is on Medicaid when they do the other things.  

Comment by JessicaStinkle on March 28, 2018 at 12:18pm

Update: so I just spoke with my states insurance commissioner and it's not actually covered. Also, because my insurance company isn't actually from my state, any laws in my state wouldn't be applicable. It is funny though because this same woman said that they had no reason to approve my claim in the prior years so it must have been a mistake; or whoever spoke to them (the insurance company) the first time from my states attorneys office got them confused. 

Also, Andrea T, I do agree with you on the technical description. Which is also why I said I don't even care anymore if they reimburse me. I would have purchased the wig, that was in my price frame, regardless. In a different perspective; insurance company's don't have to pay anything for vision contacts because they are also considered cosmetic, but most insurance's do provide coverage. So in this perspective, not wearing a wig is the same as wearing glasses (which is provided). Although if you can afford contacts (which are tremendously cheaper) your're still not bald. And, people wear glasses (and wigs) specifically for cosmetic purposes, but how many people shave their head so it's shiny, remove their eyelashes, and eyebrows for cosmetic reasons; not people who are socially 'normal'.

Comment by SabineTawni on March 28, 2018 at 1:54pm

Thanks for the info about Medicare, Hagster.  I have been on Medicare for a few years now, and I have never tried to get a wig with them.  I can afford to pay for my own wigs, but I am very very concerned for those people who cannot afford it.  I am sick to death of insurance companies picking and choosing which disease they wish to cover and which disease they don't.  We both know that the only reason they cover wigs for cancer is because of the social outrage they would encounter if they did not.  Also, with cancer being so prevalent (unfortunately), cancer patients have a much larger, more power lobbying group to advocate for them.  

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