Insurance Coverage and Reimbursement – Medical Treatment
Because scientists and researchers have yet to find an FDA-approved treatment for alopecia, obtaining insurance coverage can be challenging and frustrating1. Because of this, any treatment is considered “off-label” (used in a way that is not listed on the drug label) and perceived as a “cosmetic” treatment, rather than a medical necessity by insurance companies.
It is our hope, that with combined efforts of the medical community and research done by incredible organizations including but not limited to the National Alopecia Areata Foundation (NAAF), Canadian Alopecia Areata Foundation (CAAF), and Australia Alopecia Areata Foundation (AAAF), medicines that will effectively reverse and heal signs and diagnosis of alopecia.
Once a cure is found, companies will engage in randomized, placebo-controlled clinical trials for these treatments in alopecia areata patients and request FDA approval for those that demonstrate positive outcomes1.
But while we eagerly wait for a cure to be discovered, the alopecia community must seek insurance reimbursement for “off-label” treatments.
Insurance Coverage and Reimbursement – Wigs
Although insurance reimbursement can be tricky, there are options to file a claim to receive partial or full coverage of your cranial prosthesis, the medical term for a wig or hairpiece, if you identify as a medical patient who has permanent hair loss (such as alopecia areata, alopecia totalis, trichotillomania), or temporary hair loss resulting from treatment for chemotherapy, radiation, or any other clinical disease2.
According to the Wig Experts, most insurance companies will cover between 80-100% of the cost for your full cranial prosthesis and will allow you to receive one cranial prosthesis per year for medical hair loss2. Depending on your insurance, your prosthesis may also be a tax-deductible medical expense.
Please note that not all insurance companies will cover the cost of your wig or hairpiece (cranial prosthesis), however, there are many who do. If reimbursements are available, the amount of coverage will depend on your specific policy details.
When filing your claim for insurance coverage for your medical wig, you must use the proper medical terminology and diagnosis codes assigned by your prescribing physician when submitting your reimbursement claim.
Some Common Terms for Medical Wigs Include:
- Cranial Prosthesis (CP)
- Hair Prosthesis
- Cranial Hair Prosthesis
- Extra-Cranial Prosthesis.
If Your Insurance Won't Help Cover the Cost of Your Wig
Option 1: If your policy does not allow coverage for your cranial prosthesis and you must pay out of pocket, save your receipt in case your purchase qualifies as a tax deduction. If your medical bills are over 7.5% of your annual income, the wig may become tax deductible2.
Option 2: Speak with your doctor or social worker about local resources. Contact your local chapter of the NAAF and other foundations about qualifying for financial assistance toward the purchase of a hair piece or wig2.
Grant Assistance for Medical Wigs and Hairpieces
The NAAF developed a program called the Ascot Fund which offers financial assistance and help children and adults purchase a wig or hairpiece. NAAF will award eligible applicants up to $300 towards your purchase. The Ascot Fund is a pre-purchase program; reimbursements are not provided for any purchases paid in full either by credit card or other financial means. Since its inception in 2004, hundreds of individuals have benefited from this fund3.
You are eligible for the Ascot Fund if you meet the following requirements:
- Have been diagnosed with alopecia areata by a dermatologist or doctor,
- Are unable to purchase a hairpiece due to financial challenges,
- Are not already in possession of the hairpiece for which you are applying,
- Have not already paid for the full balance of the cost of the hairpiece.
To request and obtain the Ascot Fund Application form, please call (415) 472-3780, email firstname.lastname@example.org or visit the NAAF website. Select the “Ascot Fund” option in the menu on the left-hand side of the webpage for information.
As you review and complete your application, read the information and answer questions thoroughly, ensuring that all the steps are complete. Providing detailed responses to the questions will assist in the timeliness that your application will be reviewed. Omitted or incomplete information may cause a delay in your application process.
Once your application has been approved, you will be notified directly by NAAF staff.