Insurance for Hair Systems - LA

California health insurance, cranial prosthetics and DME wigs

If you are suffering from hair loss caused by a medical reason, there is a chance that your insurance may reimburse you for part of the expense. Causes can include chemotherapy, trichotillomania, PCOS, or auto-immune disorder.

There are several steps you must take in specific order to qualify or even submit for insurance coverage in California. These are meant as guidelines and do not guarantee that your insurance company will cover you, but if you do not submit, then there is a 100% chance that they will not reimburse you. Lucinda Ellery is not in network with any health insurance groups, and this is just for our clients. Please note that Medicare nor Medicaid currently reimburse for hair wigs, cranial prosthetics or DME Hair systems.

BENEFITS ANALYSIS

Look at your insurance benefits. If cranial prosthetics are specifically listed. If it is listed as a DME (durable medical equipment) then you are on your way. But be aware that even if it is not listed, this does not necessarily mean that it is not covered. The first thing you need to do is contact your health insurance company. Ask specifically for your benefit specialist. Explain to them what your situation is and ask if they cover either in the form of a cranial prosthetic.

Be sure to tell them that the hair system is specifically for hair loss caused by your medical condition.

If they do say that they cover cranial prosthetics, write down the time of call, who you spoke with at your insurance company and if they said it was covered. Also take very careful note of what they say should be your next step. Ask them if pre-authorization is needed.

Where your insurance benefits are concerned, every insurance company determines what they will and will not cover and it is determined by your individual policy.

DOCTORS NOTE FOR YOUR WIG OR HAIR SYSTEM

Whether your insurance covers your hair system or not, it is helpful to obtain a prescription from your doctor for a “cranial prosthetic.” This is not only important for coverage, but also if your FSA (flexible spending account) and/or HSA (health savings account) is being used as payment.

On the prescription your doctor or specialist MUST include the medical cause or condition that led to your hair loss. They must also include the ICD-10 Code (For example: S01.00xA) and the diagnosis code (A9282)

If NO Prior authorization is needed, then be sure to remind us after receiving your system that you require an itemized paid bill with our tax ID number on it.

SUBMIT YOUR CLAIM

Once you have the prescription from your medical doctor or specialist, the detailed invoice from Lucinda Ellery and any other information you can provide to them (an additional note or letter from your doctor can sometimes be helpful as well) then it is time to submit your claim.

Be sure to obtain a HcFA form from your doctor if possible to submit to your insurance company and fill it out carefully. If there are gaps or errors on the form, this can cause a rejection or delay of the decision.

If your insurance company requires prior approval before considering payment, then it is important to wait until final approval is given. This will always be in writing.

If you are denied coverage, you can still resubmit with anything they require. But again, this can take weeks to months for approval.

Even if you are denied, there is still a chance you may be able to use your FSA or HSA for payment, but this again, should be cleared with your insurance company and you should always keep the letter of medical necessity and doctors prescription together with all of your tax documents.

If you would like to schedule your free consultation, please do not hesitate to contact us.

Should you have questions regarding coverage we strongly urge that you contact your health insurance company.

 

Set Up Your Free Consultation

If you're not already a client then you can contact us to arrange a free initial consultation at our New York studio, either by phone

Tel: (310) 288-0788

or using the form on our Los Angeles contact page