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.