GUIDELINES FOR FILING INSURANCE CLAIM

 

• Check your benefits and covered expenses for the specific requirements relating specifically to "Coverage of Prosthetic Devices'.

• Make sure your doctor's prescription is for “Prescribed Cranial Prosthesis”. 

• You will also need a specific diagnosis.  For example,  if you need a wig because you have been diagnosed with Alopecia; Alopecia alone is not a diagnosis - you need to know what type. Make sure to ask your doctor to list this in his prescription.)

• Obtain a receipt from the hair replacement specialist or vendor.  The invoice must show all charges and must be paid in full. Make sure receipt reads something to the effect of: “A full custom cranial prosthesis to counteract the psychological distress secondary to (alopecia, cancer, burns, radiation, injury, surgery, etc.”)

• You will submit your prescription and claim form to your insurance company along with the receipt from your wig vendor or hair replacement center.  Most stores know this process and will be happy to assist you. It's always good to call ahead of time to make sure the wig specialist you are visiting with is familiar with this process as you want to get reimbursed correctly without any mistakes from the start.

• Note: Insurance companies cover the cost under procedure codes S8095 and A9282

• Have the physician sign off on the insurance claim form.

 

WAITING FOR THE CLAIM TO BE PROCESSED

 

Prepare yourself for in the event your claim is denied:

• Know your rights as the insured party.

• Obtain a copy of your FULL contract with your carrier (most people only have a “Summary of Benefits” provided by the employer).

• Read and know your contract.

• Pay attention to the “exclusions” Wigs are excluded for cosmetics reasons.

• Pay special attention to Prosthesis coverage. Most policies do not spell out exclusions under Prosthesis, and this is how you are likely to have your claim accepted.

 

Optional suggestions:

• Include a letter from your employer,

• Take pictures of yourself without hair,

• Hand write a letter detailing the emotional effects that your condition has had on your life.

 

The most important thing to remember when submitting a claim is to be very thorough in your documentation. When the insurance company reviews your claim, you want them to have all pertinent information needed to approve and expedite your claim.

 

Keep copies of your sales invoice(s), as your full cranial prosthesis may also be a tax deductible medical expense.

 

These steps are just for your reference. Remember to follow the procedures outlined by your insurance company to receive the maximum benefits possible.

 

I hope this information is useful for you.

 

Sincerely,
 

Kim Nicole, Owner

Kim Nicole HairXtenz Salon
655 W Arrow Highway, Suite 31

San Dimas, CA 91773
Tel: 626-383-7315
E:  info@kimnicolehairxtenz.com

www.kimnicolehairxtenz.com

 

Grants/Other Helpful Information:

 

If you don’t have insurance you could try to contact your state or county agencies. The County Department of Social Services offers medical assistance in most states for individuals who meet certain income guidelines.

 

The National Alopecia Areata Foundation (NAAF): NAAF has established the Ascot Fund which is a pre-purchase program; reimbursements are not provided for any purchases paid in full either by credit card or other financial means. It provides financial assistance toward the purchase of a hairpiece to individuals who have alopecia areata, the maximum amount rewarded is $500 and any amount beyond the award amount would to be paid by the applicant.  To find out if you qualify, please contact them at:

 

National Alopecia Areata Foundation
14 Mitchell Blvd. San Rafael, CA 94903

OR

PO Box 150760
San Rafael, CA 94915-0760

T: 415-472-3780 Fax: 415-472-5343
E:  info@naaf.org

www.naaf.org