
Losing hair due to medical conditions such as chemotherapy, alopecia, or severe burns can be emotionally and physically challenging. For many, wigs—especially cranial prosthesis—offer a sense of normalcy and confidence during a difficult time. However, the cost of a high-quality, medical-grade wig can be a concern for many individuals. The good news? You may be eligible to have your medical wig covered by your insurance.
In this blog, we'll walk you through how to get your cranial prosthesis or medical wig covered by insurance, so you can focus on feeling like yourself again. And don't forget, Adoriya is here to help you every step of the way with personalized guidance—schedule a free consultation with us today.
1. Understand the Term: Cranial Prosthesis vs. Wig
Before we dive into the process, it’s important to understand the difference between a fashion wig and a cranial prosthesis. A cranial prosthesis is a medical-grade wig designed for individuals who experience hair loss due to medical conditions or treatments such as chemotherapy. Unlike regular wigs, cranial prostheses are often made with higher-quality materials and tailored to fit the patient’s scalp, offering more comfort, breathability, and durability.
The key here is the medical necessity. Many insurance companies categorize cranial prosthesis as medical devices, which makes them eligible for coverage under health insurance plans.
2. Check Your Insurance Policy for Wig Coverage
Every insurance company has different policies regarding the coverage of cranial prosthesis medical wigs. The first step is to review your insurance plan or contact your provider to check if wigs are covered under durable medical equipment (DME) or prosthetic devices.
Here are some terms you may want to look for when reviewing your policy:
Cranial Prosthesis: This term is more likely to be covered than "wig."
Durable Medical Equipment (DME): Check if a cranial prosthesis is listed under this category.
Prosthetic Devices: Some insurance plans cover cranial prostheses as a prosthetic device.
If you're unsure, contact your insurance company directly and ask if they cover cranial prosthesis for individuals experiencing hair loss due to medical conditions. Be specific about the medical nature of your hair loss.
3. Obtain a Prescription from Your Doctor
To get your cranial prosthesis covered by insurance, you will need a prescription from your healthcare provider. Your doctor will need to provide documentation that the wig is medically necessary for your condition. The prescription should include:
Diagnosis: The medical reason for your hair loss (e.g., chemotherapy-induced alopecia, alopecia areata, etc.).
Recommendation for a Cranial Prosthesis medical wig: It’s important that your doctor uses the term “cranial prosthesis” in the prescription rather than "wig," as this is more likely to be covered by insurance.
Estimated Cost: Some insurance companies may require an estimate of the cost of the cranial prosthesis.
If you're unsure how to approach your doctor about this, Adoriya can guide you through the process during a free consultation. Visit https://www.adoriya.com/schedule-a-free-consult to learn more.
4. Submit a Claim to Your Insurance Company
Once you have your prescription, it’s time to submit a claim to your insurance company. Most insurance providers require the following:
Prescription: Your doctor’s written prescription for a cranial prosthesis.
Invoice or Estimate: Include an invoice or cost estimate from the supplier of the cranial prosthesis medical wig.
Letter of Medical Necessity: A letter from your doctor explaining why the wig is medically necessary.
In some cases, you may also need to submit before-and-after photos or additional documentation that proves the medical necessity of the wig.
5. Appeal if Denied
It’s not uncommon for initial claims to be denied, but don’t be discouraged. Many insurance companies have an appeal process that allows you to resubmit your claim. Here’s what to do if your claim is denied:
Request an Explanation: Ask for a detailed explanation of why the claim was denied.
Provide Additional Documentation: If necessary, submit more medical records or letters from your healthcare provider supporting the need for a cranial prosthesis medical wig.
File an Appeal: Follow your insurance company’s appeal process, which is often outlined in your policy.
Adoriya has experience working with insurance claims and can assist you in navigating the appeal process. Reach out to us during a free consultation for support.
6. Use Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA)
If your insurance plan doesn’t cover cranial prosthesis medical wig, you may still be able to use pre-tax funds from your FSA or HSA to pay for the wig. These accounts allow you to set aside money for medical expenses, including medical wigs prescribed by a doctor.
7. Get Help from Adoriya: Free Consultations
Navigating insurance coverage for medical wigs or cranial prosthesis can be overwhelming, but Adoriya is here to help. We provide free consultations to guide you through the process, from securing a prescription to submitting an insurance claim. Our team is experienced in helping clients get the coverage they deserve, ensuring you receive a high-quality, custom-made cranial prosthesis without the financial burden.
Schedule Your Free Consultation Today
If you’re ready to take the next step in getting your cranial prosthesis covered by insurance, schedule a free consultation with Adoriya. Our team will assist you every step of the way, making the process simple and stress-free. Visit to schedule a consult to get started today.
Conclusion
Getting your cranial prosthesis or medical wig covered by insurance is possible with the right approach. By understanding your insurance policy, obtaining a doctor’s prescription, and submitting the necessary documentation, you can reduce or even eliminate the cost of your wig. For personalized assistance, schedule a free consultation with Adoriya and let us help you get the coverage you need for your custom medical wig.
Comentarios