Insurance Reimbursement

FILING A CLAIM FOR INSURANCE COVERAGE FOR A FULL CRANIAL PROSTHESIS

  1. Check your benefits and covered expenses. Copy any page that specifically states coverage of prosthetic devices.
  2. Obtain the name of the person at your insurance company who would be directly responsible for reviewing, processing or approving your claim. Find out the exact approval procedure.
  3. Complete your claim form.
  4. Take pictures of yourself without a hair prosthesis and without corrective eye makeup. This will immediately show that your claim is not for cosmetic purposes.
  5. Detail the emotional effects of (medically related) hair loss.
  6. Ask your employer for a letter on the importance of your having hair on the job.
  7. Write a letter directly to the appropriate person explaining the details of chemotherapy, alopecia, radiation, burns, or surgery as it relates to your hair loss. Detail the emotional effects it has had on your life. Discuss the financial aspects of frequent wig purchases. Advise that cranial prosthesis is just as medically necessary as a prosthetic limb or breast it replaces a missing body part – HAIR!
  8. Enclose brochures and pamphlets endorsed by the following support organizations. This is important if the insurance company has questions during the review process.
American Hair Loss Council
The American Hair Loss Council
30 South Main Shenandoah, PA 17976
www.ahlc.org
National Alopecia Areata Foundation
14 Mitchell Boulevard San Rafael, CA 94903
Phone: 415.472.3780
Fax: 415.472.5343
www.naaf.org
American Society for Dermatologic Surgery
5550 Meadowbrook Drive Suite 120
Rolling Meadows, IL 60008
Phone: 847-956-0900
Fax: 847-956-0999
www.asds.net
American Cancer Society San Diego County
2655 Camino Del Rio North Ste 100
San Diego, CA 92108
Phone: 619-299-4200
Fax: 619-296-0928
www.cancer.org
American Academy of Facial Plastic
& Reconstructive Surgery
310 S. Henry Street Alexandria, VA 22314
Phone: 703-299-9291
Fax: 703-299-8898
www.aafprs.org
The Burn Institute San Diego County
8825 Aero Drive, Suite 200
San Diego, CA 92123-2269
(858) 541-2277 phone
(858) 541-7179 fax
www.burninstitute.org

 

 

Send a case history of a patient with the same or similar condition.

  1. Send a detailed letter from each doctor who is treating you. It is important that the doctor describes the severity of the condition, extent of hair loss, and explain that without a
  2. “Full Custom Cranial Prosthesis”, leading a normal life and being able to work would be very difficult. He/She should mention the mental distress you have experienced due to your medical treatment.
  3. A brief letter from a psychiatrist may also be beneficial, if possible.
  4. Enclose a prescription (on an actual prescription form) from the doctor who ordered the full cranial prosthesis. The prescription must use this verbiage and have the correct diagnostic code for the insurance company to process your claim. A9282 ORN-1
  5. Obtain a receipt from the hair addition specialist performing the service. The invoice must show all charges and must be paid in full. Make sure receipt reads: “A full custom cranial prosthesis to counteract the psychological distress secondary to (alopecia, cancer, burns, radiation, injury, surgery, etc.”)
  6. Explain the differences between wigs and custom made full cranial prosthesis.
  7. If you talk with your carrier by phone, insist they confirm your conversation in writing. If they fail to do so, prepare your own record of the conversation.

The most important item to remember when submitting a claim is to be very thorough in your documentation. When the insurance company reviews your claim, you want them to have the information needed to approve the claim in an expeditious manner.

I hope this information is useful for you.

Sincerely,
Dawn Harrison, President

Invisible Hair Studio
1946 Monte Vista Drive Vista, CA 92084
Tel: 760·727·9770
Website: www.invisiblehair.com
Email: info@invisiblehair.com

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