Insurance claim for medical hair prosthesis

I am curious how others may have fared when putting in a claim with their medical provider for a medical hair prosthesis (aka wig ). I submitted a claim for my daughter's on the recommendation of the provider and United Healthcare has been trying to make my life miserable by asking for one thing and once you provide it they ask for another. Most recently they asked for a letter from the doctor which she was kind enough to provide about the overall condition. Then they wanted a letter from the dermatologist about the expected permanency as it she had a crystal ball which we got and yesterday they asked for CPT/HCPC procedure and diagnostic codes. My wife seems to think that is a positive as it would appear they plan on paying the claim but I think its another excuse to discourage us from proceeding. Unfortunately, they picked the wrong person if they think that will happen. Anyone else have an experience they wish to share?

Views: 8255

▶ Reply to This

Replies to This Discussion

Permalink Reply by SPARKS the Warior on June 19, 2019 at 1:19pm

Hi Rose, would you please share what your Dermatologist put in your letter as to the why the prosthetic was medically necessary?  I am going through the VA and the Dermatologist I have has never done this type of claim before.  He is ready to give up so I'm trying to help him help me.  I have alopecia areata and have had it for a very long time, tried the injections, topicals years ago and now have scarring alopecia along entire hairline to behind my years.  I thank you and anyone else who has an answer to - "why is the prosthetic medically necessary?"  THANKS & God Bless!

Permalink Reply by HaydenBavin on January 6, 2020 at 4:18am

Although the terms and conditions of medical insurance are tough to understand also you can check here because there are some healthcare insurance companies having simplified insurance products that include hair transplants in their lineups. Patients don’t need to find a specialist as well because the listed hospitals having this facility.

Permalink Reply by alopecia mom on January 18, 2020 at 11:07pm

United Healthcare denied our claim  for hair prosthetic as it is cosmetic according to them.  Tell that to my 19 year old daughter she has been without her hair for 2 years now. They wear you down with all the letters and such and then finally say no- we did get them to approve xeljanz for a year which didn't end up working- they wouldn't approve the dose increase we wanted to try.  Now we are waiting for other options.

Good Luck 

Permalink Reply by BMG on February 25, 2020 at 9:02pm

I’m very curious if you’ve had any luck.  I have a situation I would like anyone to chime in on.  My insurance carrier is Highmark and I called them and gave them this CPT code D5924 which as it turns out is a covered benefit under my plan. It is coded as a medical prosthesis.  The part where they are trying to get me is they say yes it is a covered benefit but I have no in network providers available to me!!  So it would be out of pocket.  I’m trying to figure out how i pay for a benefit that is covered but there is nowhere I can get one.  How to fight that one?

RSS

Disclaimer

Any mention of products and services on Alopecia World is for informational purposes only; it does not imply a recommendation or endorsement by Alopecia World. Nor should any statement or representation on this site be construed as professional, medical or expert advice, or as pre-screened or endorsed by Alopecia World. Alopecia World is not responsible or liable for any of the views, opinions or conduct, online or offline, of any user or member of Alopecia World.

© 2024   Created by Alopecia World.   Powered by

Badges  |  Report an Issue  |  Terms of Service