INITIAL INSURANCE CLAIMS

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1. Receive a letter or prescription from your doctor for a “Cranial Hair Prosthesis”.

The prescription should include a diagnosis code which we will use when we

generating an invoice for submission to the insurance company.

 

2. Use the Healthcare Common Procedure Coding Systems (HCPCS) codes: S8095

and A9282.

 

3. Insurance companies also ask for a NPI Code- this code comes from a doctor. To

find the code for your doctor, use the following link to the national database: NPI

Registry Search. Search for your provider using the Individual Provider search

area. The NPI number is a 10 digit number located under NPI information.

 

4. Have a receipt from the company you purchased the Cranial Prosthesis. Make

sure it DOES NOT say “wig” anywhere and that it includes the HCPCS insurance

codes.

 

5. Have the company include their Tax ID#

 

6. Have your physician sign off on the insurance claim form.

 

7. Double check your insurance claim form to make sure you legibly included the following:

 

 •The term “Cranial Hair Prosthesis”

 •Diagnosis code

 •NPI Code

 •The billing HCPCS codes: S8095 and A9282

 •The company’s Tax ID#

 •Your physician’s signature

 

What do I do if my claim is denied?

If your claim is denied, you can choose to file an appeal. Here are some helpful tips when

appealing a denied claim:

 

1. Know your rights as the insured party and be informed. Obtain a copy of your full

contract with your insurance company (most people only have a “Summary of Benefits”

provided by the employer).

 

2. Carefully read and understand the exclusions (“wigs”) and covered items (“Cranial Hair

Prosthesis”) in your policy. See if your insurance policy calls it something other than

“prosthesis”. 

 

3. Write a letter to be reviewed by the Medical Review Board. Be sure to attach a copy of

the original claims.

 

4. In your letter, be sure to emphasize that a “wig” is a cosmetic item and unnecessary, and

that a “prosthesis” however, is necessary (comparable to plastic surgery for a burn

victim).

 

5. Address your letter to a supervisor in the Claim Department and ask for a written reply to be sent to you. Other suggestions:

 

a) Include pictures of yourself without hair and a letter detailing the emotional effects the hair loss has had on your life.

b) Include a letter from your employer

c)Understand which medical codes to use on your forms. Different conditions may require different diagnosis codes. Check with your prescribing physician for the codes related to your condition. To receive the maximum benefit from your insurance company, be sure to follow their outlined procedures. The information listed above are provided as a reference for assistance filing your claim. Also, your full cranial hair prosthesis may be tax deductible, so be sure to keep copies of your sales invoice(s) for your records as well.

 

 

Additional Resources: 

 

County Department of Social Services

• Depending on your County, sometimes they offer assistance for individuals who qualify

and meet certain income guidelines

 

American Cancer Society

• Apply for a Grant or Voucher up to $75 to cover your Cranial Hair Prosthesis (must apply before purchasing a wig)

• Apply for an allotment to cover the rest of the cost if your insurance company only covers a partial amount

• Financial Assistance for a Wig Purchase: 1-800-227-2345

 

National Alopecia Areata Foundation (NAAF)

• Pre-purchase program provides financial assistance to those who qualify