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Insurance Reimbursement

Tips on Filing your insurance claim

FILING A CLAIM FOR INSURANCE COVERAGE FOR A CRANIAL PROSTHESIS

1.Check your benefits covered expenses. Copy any page that specifically states coverage of prosthetic devices.

2. Obtain the name of the person at your insurance company who would be directly responsible for reviewing, processing or approving your claim form.

3.Complete your claim form

4.Take pictures of yourself without a hair prosthesis and without corrective eye makeup. This will immediately show that your claim is not for cosmetic purposes.

5. Detail the emotional effects of (medically related ) hair loss.

6. Ask your doctor for a letter on the importance of having hair on the job.

7. Write a letter directly to the appropriate person explaining the details of Chemotherapy, Alopecia, Radiation, Burns, or Surgery as it relates to your hair loss. Detail the emotional effects it has had on your life. Discuss the financial aspects of frequent wig purchases. Advise that cranial prosthesis is just as medically necessary as a prosthetic limb or breast it replaces a missing body part – HAIR!

8. Encloses brochures and pamphlets endorsed by the following support organizations. This is important if the insurance company has questions during the review process.

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The American Hair Loss Council

30 South Main Shenandoah, PA 17976

www.ahlc.org

Learn More

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American Society for Dermatologic Surgery

5550 Meadow brook Drive Suite 120 Rolling Meadows, IL 60008

Phone: 847-956-0900

Fax: 847-956-0999

www.asds.net

Learn More

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American Academy of Facial Plastic &reconstructive Surgery

310 Henry Street Alexandria , VA 22314

Phone: 703-299-9291

Fax: 703-299-8898

www.aafprs.org

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National Alopecia Areata Foundation

14 Mitchell Boulevard San Rafael, CA 94903

Phone: 415.472.3780

Fax: 415.472.5343

www.naaf.org

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American Cancer Society

101 Ygnacio Valley Rd, Ste 110 Walnut Creek, California 94596

Phone: (925)-934-7640

www.cancer.org

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The Burn Institute San Diego County

8825 Aero Drive, Suite 200 San Diego, CA 92123-2269

Phone: (858) 541-2277

Fax: (858) 541-7179

www.burninstitute.org

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Send a case history of a person with the same or similar condition.

1 Send a detailed letter from each doctor who is treating you. It is important that the doctor describes the severity of the condition, extent of hair loss.


2. Explain that without a “Full custom cranial prosthesis “ leading a normal life and being able to work would be very difficult . He /She should mention the mental distress you have experienced due to your medical treatment.


3. A brief letter from psychiatrist or psychologist may also be beneficial if possible.


4. Enclose a prescription ( on actual prescription form) from the doctor who ordered the cranial prosthesis. The prescription must use this verbiage and have the correct diagnostic code for the insurance company to process your claim. A9282 ORN-1


5. Obtain a receipt from the hair replacement specialist performing the service. The invoice must show all charges and must be paid in full. Make sure receipt reads: “ A full cranial prosthesis to counteract the psychological distress secondary to ( alopecia, cancer, burns, radiation, injury, surgery etc.”)


6. Explain the differences between wigs and custom made cranial prosthesis.


7. Talk with your carrier by phone, insist they confirm your conversation in writing. If they fail to do so prepare your own record of the conversation.

The most important item to remember when submitting a claim is to be very thorough in your documentation. When the insurance company reviews your claim, you want them to have the information needed to approve the claim in an expeditious manner.


I hope this information has been helpful

Sincerely,

Michelle Martin


Hair Replacement Solutions for Women

1330 North Broadway Suite F ,Walnut Creek ,CA 94596

Phone: 925-287-1100

Website: hairreplacementsolutionsforwomen.com

Email: [email protected]