Guidelines for Filing Insurance Claims: Prepared by the National Alopecia Areata Foundation and provided to the Y-ME Hotline by Jerome Krause, Fashion Hair, Inc.

Official Rx (Prescription to ask for): Hair prosthesis for chemotherapy- induced alopecia (see instructions below).
Insurance Codes: Aetna DME LOI00L9900 Other Insurance: ICD code S8095

1. Filing the initial claim

Get a prescription from your doctor. Make sure that the letter or prescription does not say “Wig,” but rather, “Hair prosthesis for chemotherapy-induced alopecia.”

Obtain a receipt from the person performing the service and make sure the receipt, also, says “Hair prosthesis for chemotherapy-induced alopecia.”

2. Waiting for your claim to be processed, prepare yourself for denial of the claim:

Know your rights as the insured party

Obtain a copy of your full contract with your insurance carrier. (Most of us only have a Summary of Benefits provided by an employer.) Your plan administrator should provide you with a complete contact and your rights

Read and know your contract:

3. Pay attention to the “exclusions”. Wigs are sometimes excluded for cosmetic reasons

4. Pay attention to “prosthesis coverage.” Most policies do not spell out exclusions under prosthesis and this is how you may win reimbursement.

5. Submitting your appeal after denial of the claim as “not covered benefit” include the following:

Ask for a review by medical review board.

Attach original claim.

Make the carrier feel ignorant for not knowing the difference between a “wig”and a “prosthesis,” and for not knowing the function of body hair.

Ask for written reply. Companies often resist putting anything in writing which may be considered “bad faith” in any future legal proceeding.

Send your letter to a supervisor in the claims department. If you send it through as you did the initial claim, the same person may receive it and reject it again.

6. If the claim is still denied, you may consider taking the insurance company to small claims court.

Insurance companies are not “God,” and you shouldn’t be afraid to challenge them.

Keep all of your correspondence, so that you are prepared. Do not rely on your memory telephone conversations. If you do talk with your carrier by phone, insist they confirm your conversation in writing. Good luck!