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Insurance denial
I was diagnosed with Alopecia in January and twice now my insurance has denied me to see a dermatologist. They keep saying the Alopecia is cosmetic. I am a mother of one and have no extra money to even buy a wig let alone pay for a dermatologist out of pocket. I need all the help I can get. In 4 months I have already lost 95% of my hair on my head as well as hair on other parts of my body. If anyone knows how or where I can get help with a wig and or doctors please let me know.
Replies to This Discussion
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Permalink Reply by Lexi on
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If your natural color hair was black, and you wished to still have black hair, you should be able to find tons of black hair wigs that are cheap. Really cheap. They are a dime a dozen. For a black hair wig, why go through all of this? Hassle with insurance companies could take forever. Numerous drs. visit and drs. letters, then play their waiting game. It should be so very simple to find a black hair wig. Even if you would like other colors, they can come in time.
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Permalink Reply by Linda Rollins on
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Hi don't give up, Who is your insurance provider? When I had Aetna, they not only approved me but I was able to get at least $500 a year for wigs. I was even able to get back pay for the years I didn't file for it. The key is, you can't listen to just to the first person you speak to on the phone, I kept calling and speaking to different people because I was told by someone that had filed that he could be done. I finally reached a lady that was willing to help and she walked me thru it and gave me her name and number so I could follow up with her, she was a christian and a very nice lady and she went out of her way to help.. The other key is there are certain codes that they must use for this condition for it to be recognized (I'm sorry I dont remember what they are). And when you file a claim for your wig, you can't call it a wig, it has to be a cranial prosthsis. Hope this help.
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Permalink Reply by Nicole Kordie on
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I have Medicaid. Single mom and don't make enough for good insurance
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I am an employee benefits manager for a large corporation and may be able to give a few tips of advise. Is your insurance through an employer? If so, ask for a copy of the SPD (Summary Plan Description) from your HR manager. This is the governing document that lists what is covered and what isn't. If dermatology is not covered, ask your employer to consider covering dermatology when they negotiate their renewal next year.
Also, if dermatology is indeed not covered, you may want to look at the plans offered through the public marketplace. Look for a policy that includes wigs for AA in their minimum essential coverage. It's common for policies to cover wigs for cancer treatment, but not AA unfortunately. Hope this helps.... good luck!
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Oh, also....think about signing up for Flexible Spending Account (FSA) if offered at your employement. This allows you to you defer up to a certain dollar amount (typically up to $2,500) of income to pay for qualified medical expenses utilizing pre-tax dollars. Wigs for AA qualify because although they're not "medically necessary" to treat AA, they do help treat the mental duress of the patient (look at the IRS regulations for qualified medical expenses). This is how I buy my daughter's wigs. My medical plan doesn't cover wigs for AA so I buy them utilizing FSA funds.
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Wigs are covered. Your FSA can't exclude them. It's an IRS regulation. Here's the publication. http://www.irs.gov/publications/p502/ar02.html#en_US_2013_publink10...
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Permalink Reply by Classical Anne in NC mountains on
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I don't know what happened to my first response to Maria, but luckily I kept a copy. As it concerns you too, Nicole, I am reprinting it here.
Maria, I appreciate your thoughtful response to Nicole. Just wanted to add that there is another type of steroid treatment that is not systemic and does not cause any ill effects. My dermatologist has been administering a low dose steroid, injected in my scalp, about 12 or so injections, every 6 weeks. They are very nearly painless -- more like just poking your scalp with a toothpick -- so I suppose the discomfort would be relative to your scalp sensitivity. It is believed that the hair loss cannot be stopped or reversed, but the injections are helping to slow the process.
I am new to this board, as I was only diagnosed [scalp biopsy] about 6 months ago. My alopecia is neither AA or AU, and I am grateful. Mine is a much rarer condition called Frontal Fibrosing Alopecia [FFA] which causes permanent hair loss, by irreversibly destroying the follicles. But it is only known to affect the area from ear to ear over the top of your head and forward from the crown, leaving relatively full hair on the back. Unfortunately, it causes an irritating, stinging sort of itch, which of course is exacerbated by wide headbands or scarves bearing down on the scalp. But so far, that is all I need for covering right now, though I am preparing to look into wigs. FAA does also bring hair loss elsewhere. In my case my eyebrows are nearly gone and my eyelashes are thinning; I've lost every single hair on my arms, except for a persistent few in my underarms. But to my disgust, the hair on my legs still needs regular shaving.
To Nicole's concern, my insurance has paid for all the injections, and paid for the hair plug biopsy. If she has not yet had a diagnostic biopsy, perhaps that would help to urge her insurance coverage. I wish her, and all of you in this conversation, success with your insurance, and encouragement from your physicians. My best hope is refusing the drop in self-esteem. It takes courage, faith, and loving support from those who are close to you.
Anne
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Hi I feel for your frustration. I don't know what city you live in but, if you have a Beauty School....ours is called M.J. Murphy Beauty school, It's a cosmetology school for hairdressers. They give free wigs to cancer or alopecia patients. I hope you have one in your town or a nearby city. I live in Michigan and our school is in Mt. Pleasant Michigan. There are other schools in Michigan. You can look schools up on the computer and google it Do you live in Michigan?.
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I'm in Avondale Arizona
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Permalink Reply by cwincos on
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I ran into the same problem with my insurance. I had to wait until my alopecia progressed to universalis. At that point with a lot of phone calls you should be able to get the appointments covered. It's not until you loose eyelash, eyebrow and nose hair that its no longer considered just a cosmetic problem. Once you start loosing the eyelashes, get to your primary care Dr and get the diagnosis changed from alopecia to AU then keep calling and asking for supervisors.
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Hi. Cosmetic? Bull crap. My name is Mark & I have had AU for over 45 years. I wore wigs for about 35 of those years and finally took the last one off about 10 years ago. First of all this is not a Dermitological problem it is a Endronological condition, which requires the help of a internal medicine specialist, an Endocrinologist. He or she will most likely tell you that there is no cure for this condition. But that is the type of doctor you must see. When I was wearing them I paid an average of 250.00-350.00-400.00. My parents paid for the first few. And I replaced the old one with a new one about every 3 years. But in all that time I never thought to inquire about insurance paying for any of it, until about 12 years ago. I have read some posts on here from people over the years who have had golden insurance policies, that even covered 2000.00 wigs. However, my Etna insurance at the time told me that they would only pay for the basic cost of what the hair piece cost my salesman at Kings Head hair goods in Milw. In other words if the owner of the wig store's cost to buy the wig from the vendor was 200.00, and if his mark up was another 200.00, making the cost to me 400.00, the insurance would only pay the 200.00 cost. Secondly at the time the Insurance people said that they would only pay if I bought a wig from their so called network, which at the time only included a store that sold prostetic limbs as a main product and cheap wigs on the side. But the worst came when I said to the insurance woman over the phone, "Why don't you pay more towards the wigs and why don't you let me buy one where they sell them, customize them, style them, etc? Her response: "Because well its not something you really need." I said, "how dare you. You know, this is why people hate insurance companies so much." I hung up. So I think it may depend on what insurance you have. I would say if you can, drop your current insurance company, unless you ask them and they say that they will pay for a visit to an endocrinologist. Call other insurance companies and inquire about if or how much they would pay for the wig. But I have never heard of an insurance company denying coverage even for a doctors (endrocrologist) visit for this type of condition unless like it sounds your is just too stupid to know what this is. I feel that just about any other company would be better than this. Take care, Mark S Hansen in Milwaukee.
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