QUESTIONS TO ASK YOUR INSURANCE COMPANY TO LEARN IF A WIG (CRANIAL HAIR PROSTHESIS)or Custom Breast Prosthesis IS IN YOUR BENEFIT PACKAGE
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
Call the CUSTOMER SERVICE phone number on the back
of your insurance card.
- 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!
- Tell the agent that you are being
treated for cancer, alopecia, trichotillomania, scars, etc. and that you have a
prescription for a wig.
- 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
- Ask how much they will pay and how often a wig will be funded?
- Have you met your DEDUCTIBLE and OUT OF POCKET......will
there be a co-pay & what percentage of the wig it will pay?
- 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
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.
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.