Effective immediately, Aetna is now requiring a pre-determination for ALL Wig/Cranial Prosthesis verifications.
Aetna has advised this change is effective January 2023. For the pre-determination, we required the following items:
• Current medical records "Progress Note" from an office visit within the last year showing medical necessity for the cranial prosthesis.
• A prescription for the cranial prosthesis with both a cancer and hair loss/ alopecia ICD-10 code.
Once a pre-determination is submitted, please allow up to 30 business days for a decision to be made.
If your policy does cover a partial or full cost of your cranial prosthesis, we can file a claim. We will need you to provide us your:
* State ID
* Medical ID Card
* Rx/Prescription from your doctor for "Cranial Prosthesis".
"Included procedure diagnosis code associated with Hair Loss/Alopicia, is needed. It’s important that the prescription does not say “wig”. It is medically necessary to have a Cranial Prosthesis A9282 on the prescription."
*Signed Consent Form
Consent Form is provided by Wigs 360°.
It depends on your insurance policy if you are required to pay upfront and then be reimbursed or if they will pay for your prosthesis upfront.
We confirmed that you can be covered between 80-100% of the cost for your cranial prosthesis and will be allowed to receive one cranial prosthesis per year for medical hair loss.
Not Covered By Insurance...
What To Do If Your Insurance,
Won’t Cover Your Wig Cost…
Option 1. If you’re paying for the wig yourself, save your receipt for possible tax-deductible opportunities. Remember, your wig is tax deductible if your medical bills exceed 7.5% of your income.
Option 2. Speak to your social worker or doctor about local resources! Call your local division of the National Alopecia Areata Foundation, the American Cancer Society, and other foundations. Depending on their requirements, you may be able to qualify for financial assistance toward a wig or hair system purchase.
Best Regards, Karina.