Wig coverage - help!

lizardesque

When I was diagnosed in November, I was relieved to review my insurance policy (Cigna) to see that they covered wigs (ie, cranial prosthesis). I got a prescription from my doctor, got a wig, and submitted the claim. There was a bit of back and forth initially (confusion over the proper codes), but that was straightened out, and the claim was resubmitted. Now, my claim is being denied for the vendor being an out-of-network provider. It never even occurred to me that there would be in/out of network providers for wigs. Plus, I did a search through Cigna, and I found no relevant results for providers of cranial prosthesis. I did an online chat via the Cigna website to see what they could tell me. The only thing they were able to tell me was that their national provider of hair prosthetics was something called Linkia, which is not a provider, but a network management organization.

Has anyone dealt with something like this? Do I have any recourse? Obviously, I purchased the wig months ago and was counting on being reimbursed for it--thousands of dollars! I can't help but feel that Cigna is purposefully opaque about this to avoid having to pay.

mustlovepoodles

You are right--Cigna will do their best to not pay. I sent you a PM.

DLJ46

Hi lizardesque,

Late 2017 Cigna told me that I was covered for a wig by 1 provider that was a 4-6 hour drive away. After searching additional computer screens Cigna did say I had an out of network benefit for wig coverage as well. Cigna said there was no cap on the amount I could spend on the out of network wig. So I buy a $1000 wig locally and submit the claim. Of course, it was denied for being out of network. Since I had a reference number for the conversation I had with Cigna regarding out of network coverage, they eventually paid the claim 2 months later.

Maybe your Cigna has to look a bit deeper into your policy for that out of network benefit? It always took me severe phone calls to Cigna to find that hidden info.

Take care

BellasMomToo

Last year I almost used an out of network provider for my breast prosthesis. I called BCBS and was told that it would cover 60%, but I would have to meet the OON deductible first. Since I was no where close to meeting my OON deductible, I would have paid 100% of it.

Fortunately I found one in-network provider fairly close by and got my prosthesis there. BCBS paid 100% for it.

Perhaps Cigna is 'covering' the cost of the wig but you have an OON deductible that has to be met first? (Just a thought.)

sbelizabeth

From my experience, it's not the actual insurance provider (Blue Cross, CIGNA, etc.) it's the plan you carry.

I have learned over the years to read my policy carefully, keep every receipt, bill, and EOB, and keep detailed notes of every phone conversation.

Every insurance provider, no matter the plan, will do their best not to pay.