No, a cranial prosthesis is just a medical term for a wig so it doesn't guarantee that the wig is any different than a "normal wig".

Unfortunately, there are no regulations or requirements for "medical wigs" that are categorized as cranial prosthesis. This makes it confusing for consumers to know if they are buying a "fashion wig" or a "medical wig".

A "fashion wig" is commonly known as a "Halloween wig" or a "party wig". These wigs are not made to last a long time and they were not designed to be worn all day, everyday. They tend to look fake, fit poorly and they can be very itchy to wear.

Again, there are no regulations or industry requirements for "medical wigs". In general, medical wigs should be specially designed for people with hair loss due to medical conditions like alopecia, chemotherapy, lupus, etc.

A medical wig should be comfortable to wear all day, fit you well, look real, and last at least a year. Sadly, because medical wigs are not required to have specific elements, a normal "fashion wig" could be sold under the medical wig category so it is very important for consumers to educated on critical parts of the wig that make them more comfortable to wear, look more realistic and fit like a dream prior to making a purchase.

Again, because, medical wigs aren't certificated or controlled so the quality varies greatly across the industry.

At Encelia Hair, we believe medical wigs should be comfortable, secure, and natural-looking. It's the little things that make all the difference:

COMFORT

• All of our wigs are double-lined with a cooling spandex base so they are buttery soft, breathable and lightweight.
• Seamless edges you will never feel the wig - every seam is seamless so our wigs will never dig or rub against your head.
• Hand-tied wigs for a super lightweight barely there feel.
• Closed wefted wigs provide a durable, economic wig that is still comfy because the inside is lined with our cooling mesh.

SECURITY

• Size matters | We believe medical wigs should be secure without the need for glue, adhesive or wig grips. Multiple cap sizes are required for a secure wig fit. We proudly offer two sizes in our Headband Wig and five sizes in our Lace Front, Gripper wig.
• The interior of our Lace Front, Gripper wig includes a ultra-thin silicone headband that grips to the head which keeps your wig secure all day.
• The 1/4" invisible soft, Swiss Lace Front, Gripper wig is folded so your lace front will ever lift. It also doesn't need to be cut after you buy it either. Your hairline will look flawless and you won't need to use any adhesive to keep it snug throughout the day.
• The interior of our Headband Wig includes an elastic band inside the headband, which keeps the wig secure all day.

REALISM

At Encelia, we believe all wigs should look real regardless of the hair type. Our luxury caps are the same across the board reguardless of the hair type you choose. We offer women three hair choices (Remy human hair, Luxury synthetic, Heat-friendly synthetic) giving you the freedom to buy hair that works best for you while still providing you with hair that looks, feels, and moves like healthy human hair.

• Our Lace Front, Gripper wig includes invisible, soft swiss lace front and each hair is single hand tied so the knots are invisible.
• Our Lace Front, Gripper wig includes a 3" silk top, hides the knots and looks like real scalp.
• Our Headband Wig is 100% hand-tied so you can style your hair up or down. Top knots, braids, etc).
• All of our hair types can be styles using heat tools.

While there are some insurance companies that allow wig coverage for medical hair loss, most do not.  Most insurance companies follow the standard set by Medicare guidelines, and since Medicare does not allow coverage of wigs, most insurance companies have the some positioning. 

Medicare gets their direction from Congress and currently, there is a bill in Congress, House bill, H.R. 4034 and Senate bill S. 1922. that would allow Medicare coverage of wigs. 

The absolute best way to get your wig covered by insurance is to go to the H.R. 4034 bill page, and click on the Contact Your Member under the "Give Feedback On This Bill" section, enter in your information and then reach out to your local Congress members.

Let your Representative and Senators know that you suffer from medical hair loss and that a wig is essential to helping you live a normal life. Explain to them how different you are treated when you don't wear your wig and how wearing one helps you feel normal. It's important for us to educate Senators and explain to them why we need wigs and help them understand that we do not wear wigs for cosmetic reasons but instead we wear wigs to feel normal and how, like other prosthesis, a wig helps us feel normal and socially accepted.

No, we're currently working very hard to become an in-network provider for several insurance groups, but, because cranial prosthesis/medical wigs are not covered by most insurance groups. Therefore, most insurance groups will not add any providers under this DEM category.

This means that Encelia Hair is considered to be an out-of-network provider for cranial prosthesis/medical wigs under the Durable Medical Equipment (DEM) category, which means you would be reimbursed after you file a claim with your insurance company. After you make a purchase, Encelia Hair will provide you with a PDF version of your receipt. You would submit your receipt along with your Doctor's prescription to your insurance provider for reimbursement.

If your claim form asks for a provider name, ours is Encelia Hair LLC. If you need our NPI number or our Tax ID number, please email or call us. Email help@enceliahair.com or call 858.356.2290, Monday–Friday, 9:00 a.m.-5:00 p.m. PST.

Note: If you are reviewing your insurance policy and do not see cranial prosthesis listed, this does not automatically mean that you don’t have coverage. We highly recommend calling your Health Insurance Provider and getting pre-authorization.

Call and ask:

• Does my policy covers a cranial prosthesis? Or other terms like other terms, hair prosthesis, scalp prothesis, cranial implant, medical wig, hair prosthesis, and full cranial prosthesis.
• If yes, when is a "cranial prosthesis" is covered? (i.e. for chemotherapy, burns, etc.
• Is it for any wig or for a specific wig like synthetic wigs or human hair wigs, etc.)
• How much will they cover? Full, partial, or a specific dollar amount?
• What specific terminology do they need in the "prescription" for the wig? (full cranial prosthesis or hair prosthesis, etc.)
• What specific documentation do they need you to submit with your claim?

• First, determine the specific terminology your Health Insurance provider requires.
• Ask your doctor or physician for a prescription. Make sure your prescription includes the medical procedure code (common codes are A9282 or D5924).
• Don't say the word, "wig". Make sure the prescription does not say “wig.” The term "wig" is commonly known or referred to as a fashion item, meaning your wig is not medically necessary causing your claim will be denied.
• Explain why the wig is medically necessary: Write a letter explaining your hair loss and its effects on you; stating that it is not simply for cosmetic reasons but for emotional well being and then ask your physician to sign this letter.

In order to be reimbursed, you need to file a claim with your insurance company.

After you make a purchase, Encelia Hair will provide you with a PDF version of your receipt. You need to submit your Encelia Hair receipt along with your Doctor's prescription along with the letter that your wrote to your insurance provider for reimbursement.

If your claim form asks for a provider name, ours is Encelia Hair LLC. If you need our NPI number or Tax ID please email or call us. Email help@enceliahair.com or call 858.356.2290, Monday–Friday, 9:00 a.m.-5:00 p.m. PST.

GENERAL REIMBURSEMENT TIPS

• Take notes of conversations, specific language when you speak with your insurance provider.
• Follow up with your insurance provider consistently to get updates on the status of your claim.
• Keep copies of all of your documentation and invoices from your physician and from Encelia Hair.

Yes, wigs are eligible. FSAs and HSAs cover Cranial prostheses under their health category and you can expense up to $2,500.

If your medical bills are over 7.5% of your income than your wig is tax deductible.

• Keep copies Encelia Hair receipt and Doctor's prescription for tax exemption purposes.
• Speak with your tax advisor about your medical bills learn about all tax deductions that are available to you. 

Prior to making a purchase, if you email us your at Doctor's prescription we will remove the sales tax with your order.

• Email us at help@enceliahair.com
• Send us your Doctor's prescription. We need a copy of your Doctor's prescription for auditing purposes.

Yes, Encelia Hair offers financing options through Affirm and Klarna - learn more here.

• Learn more about how Affirm works - here.

Many hospitals and cancer centers have private wig banks, which provide wigs to people in need with a free. Contact your local hospital or care coordinators to learn more about programs in your area.

Alternatively, you can also reach out to Naaf and the American center society to learn about their wig donation programs.

Blue Cross Blue Shield does not cover wigs as a cranial prosthesis for group and individual insurance plans.

Aetna's group medical insurance plan does not cover wigs as a cranial prosthetic. However, individuals should verify with Aetna that the individual plan they are on will cover this item or not. 

United Healthcare does not cover cranial prosthesis under group medical insurance plans. However, individuals should verify with United Healthcare that the individual plan they are on will cover this item or not. 

Medicare will not pay for a cranial prosthetic wig even if the claim is filed under durable medical equipment. This means that anyone over 65 years old that has a medicare advantage plan or a medicare supplement plan, these plans will not pay for a wig. This has been confirmed by a Medicare Representative.

Ambetter does cover cranial prosthetic wigs under individual policy plans. Check with your insurance representative to see if your plan includes cranial prosthesis coverage.

Humana does not cover cranial prosthesis under their group insurance plans.

Baylor Scott & White does not cover wigs as a cranial prosthesis.

Oscar does cover 50% of cost for cranial prosthetic wig under individual policy plans and group medical plans. Check with your insurance representative to see if your plan includes cranial prosthesis coverage.

Molina does not cover cranial prosthetic wigs under individual policy plans.

Cigna does not cover cranial prosthetic wigs under individual policy plans.

*pending verification

*pending verification

ChampVa does cover cranial prosthetic wigs that are approved through their online system. Check with your insurance representative to see if cranial prosthesis is included.

TriCare does cover cranial prosthetic wigs under individual policy plans. Check with your insurance representative to see if your plan includes cranial prosthesis coverage.