Insurance Info

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Wigs, Post Mastectomy and Health Insurance

  Comfort Wigs, Etc is an approved provider for almost all insurance/healthcare networks in North Texas. Unfortunately, the  administration costs were prohibitive, often taking up to 5 employee administration hours and usually 7 weeks to 16 months to get partial payment from the insurance companies for each wig.

Comfort Wigs, ETC  had gone through rigorous screening for professionalism, privacy, liability, quality, licensing and pricing by almost all  insurance companies. We can help the patient/client learn to check benefits and we will file the insurance claim for you and have the money sent to you if the wig is included in your benefit package.

MEDICARE WILL NOT PAY FOR ANY PORTION OF A WIG , REGARDLESS THE REASON FOR HAIR LOSS

The only wig boutique in North Texas that will bill insurance companies for a wig. Any of our staff can answer questions regarding fees and billing policies

  1. With over 450 wigs in stock, we offer a wide range of wigs to meet most customers’ style needs and budget.

  2. 98% of wig styles come in average size and only about 55% of people’s heads are average size. This means that about 45% of the wigs need alterations to get them to fit the head properly.

  3. A wig can be properly sized or altered if the client has very short hair or no hair. If you elect to get the wig before your hair is lost, there is an additional alteration fee when you return for alterations after hair loss.

  4. Insurance companies do not automatically cover the cost of a wig. The amount an insurance policy pays for a wig is determined by the benefits your employer negotiated with the healthcare plan.

  5. Some insurance companies say they cover a wig, and then reject the claim. THE CUSTOMER IS ULTIMATELY RESPONSIBLE FOR ANY BALANCE NOT PAID BY THEIR INSURANCE COMPANY, REGARDLESS OF THE REASON.

  6. If you have any questions regarding your specific insurance benefits, we ask that you contact your company regarding the details of the plan it is conducting on your behalf.

  7. Please do not hesitate to ask us questions about our office policies. We want the client to be comfortable in dealing with these matters and we urge the client to consult with us if she has any questions regarding our services or fees.

  8. A prescription from your physician is required for billing. The prescription saves you sales tax on the wig and qualifies the wig as a medical tax deduction. A prescription does not guarantee that a customer’s insurance company will cover a wigThe proper prescription will include the patient's diagnosis code as well as the physician's NPI and UPIN numbers.

  9. Wigs are subject to ‘wear and tear’ like an article of clothing and will require some maintenance. Wigs that are collar length or longer are subject to “friction frizz” that can be remedied with a plastic hot air brush.

  10. Under penalty of Texas law, we may not sell a used wig. You may not return a wig after it leaves the store except for manufacturer defects.

  11. The customer is responsible for the cost of the wig if the insurance company declines benefits for any reason.

  12. The customer is responsible for getting their prescription and other documents required by their insurance company prior to billing of the wig.

  13. The customer is responsible for expedite shipping fees, i.e. overnight.

 

We are in-network, with the following insurance companies:

AEtna Blue Cross, Blue Shield
Cigna Health Services   ppo Next
Accountable Healthcare   Healthsmart
Independent Physicians of Denton County   ProNet
North Texas Healthcare   Multiplan  
United Healthcare    Medicare (Does Not Pay For Wigs)
Galaxy Healthcare   One HealthPlan of Texas - Great West
Unicare   Texas True Choice
Beech Street   PHCS

 

Wig Insurance Information

 Many networks pay for all, or a large portion, of a wig for medically induced hair loss, depending on the annual deductible and Out Of Pocket expenses met . These reasons may include chemotherapy, radiation to the head, alopecia and trichotillomania (hair pulling). Aetna seems to be the company most likely to cover a wig for alopecia or hair pulling.  Medicare DOES NOT pay for wigs no matter the reason of hair loss.  Since wigs, or cranial hair prostheses, are covered under some healthcare policies, it is imperative that benefits be checked for each individual patient. Also understand that even though your policy may cover a wig, they may cover only a potion of the wig, or not at all.

Wig benefits (in your insurance policy) are determined by your employer who each year negotiates with the insurance company for a healthcare package that best meets the employer's and their employees needs.  Therefore, wig benefits are a contractual issue and, basically there is nothing that can be done to get your wig paid for by the insurance company if a wig was not originally included as a benefit. Comfort Wigs' staff was surprised that one company's policy paid for a wig only if the policy holder was being treated for breast cancer.

  Try going to your employer's human resource manager and negotiate with them to pay all or part of the wig, because "you need a good wig to be presentable and self confident at work, and it will help you psychologically in the healing process." An attractive wig helps co-workers to not focus on the 'co-worker with cancer'.

  Items not covered by insurance networks in most states are: wig care products and services, the wig cut and style, hats, turbans, scarves or any other head-coverings, however, several states do require insurance companies to cover head-coverings. Check with your state.

Mastectomy Products

  The Women's Health and Cancer Rights Act of 1998 requires insurers who provide coverage for mastectomy surgery to provide coverage for:

  • Reconstruction of the breast on which the mastectomy was performed
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance
  • Prostheses and physical complications for all stages of mastectomy, including lymphedema, in a manner determined in consultation with the attending physician and the patient.

  In essence, Federal Law mandates that healthcare providers who cover the cost to remove a breast due to cancer must also cover the cost of reconstruction and / or mastectomy products. There are exceptions to every rule, i.e., self-insured groups, in some cases, will not cover.

  The reason for this Federal Mandate is health as well as aesthetic.  When a breast is removed the loss of that weight on one side will throw you off balance.  Your body compensates for that loss, which now effects your neck, shoulders and back and causes even more problems down the road.

  Each healthcare provider has different 'standards' as to the number of products and the frequency of purchase. Most insurance companies we work with allow 1 breast prosthesis (2 if you are bilateral) every 2 years and 2 to 4 mastectomy bras each year. And, of course, there is always your deductible. Your deductible must be met before insurance will pay for these products.

  Most insurance companies will also cover the BALANCE products, so check that out also. Lumpectomy surgeries can include removal of the affected portion of the breast. Companies that manufacture breast forms produce several products that replace the removed tissue with partial breasts that are available in several shapes and up to 14 sizes to fill-in or balance the affected breast with the other breast.

Insurance Questions



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.