For the last two years I've successfully received reimbursement for my wig once a year for $350. It's always been a fight, the first time I had my states attorneys office step in, the second time I was able to do it on my own even after the claim was initially denied. This time I am completely unsuccessful. I contacted the states attorneys office a while back but never got a response. Now I was just told that my claim would not be granted because it is "cosmetic". Which is BS on its own because they previously denied me because I had the wrong diagnosis code, I gave them the correct one and now it's denied because they don't cover this comesmetic claim, I could care less about being reimbursed at this point, but it's about the principle. I happen to live in a state that requires reimbursement for at least $350 a year and includes alopecia areata as a reimbursable claim. Unless I'm reading this statute wrong, I'm right. I'm so frustrated and I don't know what to do about fighting this last denial of my claim. Any suggestions?

Views: 1866

Comment by Danielle on March 28, 2018 at 2:32pm

I always got a "prescription" from my primary doc for a scalp hair prosthesis not a "wig"  It should not be called cosmetic but a prosthesis and filed that way with ins.  Most insurances companies are specific about alopecia being covered.  I haven't got a new one in a while but they covered part of a repair on a piece I have.  They seem to cover much less of the cost then before but maybe try that.  Good Luck

Comment by Pat Pro on March 28, 2018 at 3:49pm

I am a resident of NJ, diagnosed with Frontal Fibrosing Alopecia by my dermatologist.  I purchased a wig and was initially denied.  My dermatologist wrote a new rx with another code and a letter.  I was reimbursed for the full amount available, which is $500.00 per year under my plan.  I don't know what will happen now that I am on medicare.  If anyone knows, I'd appreciate the information.  I hope my information here is helpful.  Good wishes to all. 

Comment by ksed5473 on March 29, 2018 at 1:32pm

I have NEVER received reimbursement for a wig and I had a script for cranial prosthetic for indication alopecia as well as a hand written letter form my dermatologist - a well know hair loss doctor in Philly. They even offered to help me fight the cause because they understand the struggle.  It actually angers him that it such a fight for reimbursement.  My ins company (Cigna) simply does cover for a wig unless it is for cancer. That was straight out of the Cigna reps mouth. I spoke to several people and never got anywhere and have been out of pocket thousands of dollars. I finally stopped submitting to ins because I would get so upset, angry, frustrated that it was causing me so much stress and the stress wasn't worth it.  My accountant said I could expense it as a medical expense so that is what I ended up doing and will continue to do whenever I need to buy another wig so I don't feel completely screwed out of money.

Comment by hagster on March 29, 2018 at 2:36pm

the only way that you can deduct your wigs on your federal taxes is:  total 'qualified' medical expenses in excess of 7.5% of your adjusted gross income.  not sure even the govt considers wigs as a qualified med expense.  example:  agi is $40,000.  if you had $3500 in out of pocket med expenses, then you can only use $500 as a deduction - which is the amount over the 7.5% limit.

that goes thru 2018, then changes to only out of pocket med expenses in excess of 10% agi next year.

Comment by bcartervt on March 29, 2018 at 4:52pm

It's called a cranial prosthesis and it should be covered.  It's no different than any other prosthesis and it's not for comestic or technically cannot be considered a wig.   I had to fight with insurance. I had a script from my Dr and a paid receipt. I finally was reimbursed.  I get 850 towards a wig every three years. This one was 350 and they don't last a year before they start breaking down. Good luck.  I feel your pain. 

Comment by april on March 31, 2018 at 10:28pm

I actually do not wear a wig and I am fine going bald....just got used to it and I am so much more comfortable. However, insurance denying wigs is ridiculous. It is not cosmetic always. For many, it is about self esteem and ability to carry on with daily life feeling confident. Maybe we should just use our insurance more and more to an excess and make multiple derm .appointments and other endocrine specialist, etc..and let them bill our insurance thousands of dollars for the diagnosis which ultimately has no cure! Seems to me like $350 ins. payment for a wig would be much wiser for the ins. company.

Comment by andrea t on April 1, 2018 at 2:26pm

You are gutsy and I admire and envy you!

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