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Insurance reimbursement for Cranial Prosthetics
Ok, so after much thought and discussion I would like to know how many of you pay tax on your cranial prosthetic.? Do you know that wig salons if do not have to charge tax if you provide them with a doctors prescription . I am married to a CPA and the tax law tells us that. This is like any other prosthetic, be it a arm or a leg prosthetic .How can we get these wig salons and internet companies to learn and act according. We need to ask them to ask their accountants so they can hear it from the horses mouth, so to speak.
Another thing we need to get working on as a community of people with Alopecia is to get the right paperwork into medical insurance companies so that we can be reimbursed for our cranial prosthetics. How do we do this, we need to be sure we code the reimbursement forms correctly with the diagnostic code and the code for a cranial prosthetic. Then we need the doctor to write that letter to support the need for a cranial prosthetic and finally a prescription from the doctors pad. People, we not only need good wigs for those that decide to wear them, we need to work our insurance companies to reimburse us a portion of the costs. I have been lucky and successful, now that being said, all insurance companies are as different as the companies we work for. However, I am game to help anyone with advice and guidance on how to get this reimbursement.
Glad to get that off my chest.
Replies to This Discussion
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Permalink Reply by Rose on
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Absolutely! My dermatologist wrote a letter stating I presented with a severe case of Alopcia Totalis. That gave Aetna what they needed to approve reimbursing me 80% of the "allowed" amount. It didn't pay for it all, but I received about $600 from my medical insurance.
ALSO, when I had bought FREEDOM pieces at $5,000, I absolutely did include them in my medical expenses - if you are itemizing. Granted, medical has to be pretty high to itemize (Like 7% over your adjusted gross income) BUT if you have other medical bills... BE SURE TO ADD THE COST OF YOUR PIECE to your medical itemized deductions.
ALSO, my insurance never told me they paid for a wig, or prothesis. I had to dig, and ask. They like saying no... I'm just sure of that! So if you have AETNA, you have coverage. GO GET IT!!
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Permalink Reply by Christine on
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I do not pay tax on my grippers, the dr wrote the RX and they keep it on file. As far as the insurance goes that's a different story, I spoke with them some years back, the first time I asked about it I was told they only pay for one wig for chemo patients one time $250 the second time I was told that they no longer even do that, and cranial prosthetics were not covered! The woman I spoke with was very understanding and agreed I had a valid point. I'm not 100% sure but I think they don't pay for any prosthetics, legs,arms?? We have a major insurance carrier so it's very discouraging given the expense.
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Permalink Reply by Alo-mom on
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Yes, as I mentioned all insurances handle the prosthetics differently. In addition, they change the coverages too. Did you submit a claim or just ask over the phone? Do you have the correct diagnotic codes for the condition as well as for the prosthetic? Just curious.
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So if you know about billing and coding in the medical field...you know that a new coding system is in place. The new codes are called the ICD 10 codes. Update your code to L63. (the ICD 10 version of 704.01)
This worked in my recent claim to AETNA for reimbursement on my hairpiece. Notably, at first all they did was kick my claim. Said "not covered" GRRRRR. When I called and asked for more details, I found that it was kicked because the code had changed. THEY GAVE ME THE NEW CODE.
In short, the ICD 10 code for alopecia totalis is L63. Hope this helps somebody else get reimbursement.
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