Questions to ask Insurance

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QUESTIONS TO ASK YOUR INSURANCE COMPANY TO LEARN IF A WIG (CRANIAL HAIR PROSTHESIS)or Custom Breast Prosthesis IS IN YOUR BENEFIT PACKAGE

OUR LOCATION

 Before checking coverage, you need a prescription for a wig and the Rx must include your diagnosis code...the ICD 10 and the Dr's NPI #

 Make sure Comfort Wigs ETC is in their healthcare network. CWE's NPI is 1689850513 and Federal tax id is 75-1896044

Please write down all insurance information answers.

  1. Call the CUSTOMER SERVICE phone number on the back of your insurance card.
  2. Tell the agent that you would like to find if a CRANIAL HAIR PROSTHESIS, under the Durable Medical Equipment section of your policy, is in your benefit package.  Do not say wig because the agent will assume it is cosmetic. The agent will ask where the service will be performed. This is VERY IMPORTANT!! Reply with "The service will be done AT HOME".  THIS IS KIND OF A TRICK QUESTION. THEY WANT YOU TO SAY THE SERVICE IS PREFORMED 'IN THE OFFICE' AND THE CLAIM WILL BE DENIED!
  3. Tell the agent that you are being treated for cancer, alopecia, trichotillomania, scars, etc. and that you have a prescription for a wig.
  4. The computer code for a WIG is A9282 and the TruLife Custom Breast Prosthesis is L8035. The CPT code for a breast prosthesis ( form) is L8030 and CPT code for bras is L8000.
  5. Ask how much they will pay and how often a wig will be funded?
  6. Have you met your DEDUCTIBLE and OUT OF POCKET......will there be a co-pay & what percentage of the wig it will pay?
  7. Get a REFERENCE NUMBER! It is IMPERATIVE to get the agent's first name, last initial, and a reference number, also note the day and time you spoke with the rep. This information will allow you to access the detailed notes and recording for up to 24 months and contest the denial as a mis-quote.

Frequently, the insurance company will deny the claim even though it was approved. If so, you are responsible to fully pay the claim.

If the wig will be funded, the agent will advise you what percentage of the wig will be covered. The agent will tell that it will pay 100%, 80%, etc of the CONTRACTED AMOUNT . If you select a wig costing more than Comfort Wigs ETC contract amount, you must pay the difference between the contracted amount and the cash discount price. Example: Aetna will pay no more than $300.00 for a wig. ie. If you want a wig that the cash discount price is $650.00, then you must pay $350 upgrade.

Often an insurance company will request a Letter of Medical Necessity be submitted with the claim. The letter is your responsibility to obtain. All you need to do is simply contact your Dr.'s nurse for a letter explaining why you need a wig, then she can fax it to CWE at 972-316-8885.

Our wigs have a cash discount price posted, but to compensate for our extra work, expertise, and payment time lag when billing, we bill the regular price to the insurance companies.

We cut, steam, size and style the wigs to a much greater extent than other wig stores and are willing to perform needed 'tweeking' after you work with the wig for a few days. Our contracts with the insurance companies demand that we bill only for the wig. Products and service costs are your responsibility.

The client almost always receives an Explanation of Benefits a few days before CWE receives it. Therefore you will be aware of denials or extra charges before CWE gets notification, so if you owe extra on the claim then you will not be surprised when you receive a notice from CWE.

Medicare never has and never will pay any portion of a wig even though a person at the infusion clinic may tell it will. If you doubt us on this information, please call 1-800-MEDICARE for clarification. A few SUPPLEMENTAL POLICIES will cover a wig if you submit the Medicare EOB Denial to the supplemental plan.

Most MEDICARE ADVANTAGE PLANS will not pay for a wig, but it may be worth a try. However, Comfort Wigs ETC is not in network with "Medicare Advantage Plans" who may pay. The Affordable Healthcare System may say they will pay for a wig but not one wig provider is in network.



500 E. Round Grove Rd, Suite 306
Lewisville, Texas 75067
214-488-8885 1-866-383-8885
FAX 972-316-8885

Open 9:00 to 5:00 Tuesday thru Friday
and 9:00 to 3:00 Saturday
Closed Sunday & Monday.



500 E. Round Grove Rd, Suite 306
Lewisville, Texas 75067
214-488-8885 1-866-383-8885
FAX 972-316-8885

Open 9:00 to 5:00 Tuesday thru Friday
and 9:00 to 3:00 Saturday
Closed Sunday & Monday.