Insurance Resources

Alopecia areata is an autoimmune disease. Hair loss due to alopecia areata is not “cosmetic;” it is a symptom of an underlying medical condition. Commercial health insurance plans vary, but some health insurers cover costs associated with treatments and wigs.

Insurance Reimbursement for Wigs

For many people living with alopecia areata, wigs are tools that help them feel confident and more “like themselves.” Exploring the world of wigs can be overwhelming as there are many types, styles, and makers to choose from. Some health insurers reimburse some or all of the cost of a wig for people with alopecia areata. Visit “How to get your wig costs reimbursed by your health insurer” for more information.

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Insurance Coverage for Treatment

As of 2022, there are FDA-approved treatments available for those with severe alopecia areata-Olumiant® (baricitinib) and Litfulo® (ritlecitinib). These medications are oral Janus kinase (JAK) inhibitors, a class of medication that has been used for other conditions for many years.

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Unfortunately, insurance companies are not always up-to-date on the latest FDA-approved treatments for conditions like alopecia areata. This means obtaining coverage for treatment may take multiple steps, including requesting prior authorization and appealing denials. NAAF is developing resources for patients to help obtain coverage for these approved medications and will launch them very soon – stay tuned!

Additionally, manufacturers of Olumiant and Lifulo offer patient assistance programs. Learn more:

• For Olumiant (baricitinib) prescriptions ONLY, visit Eli Lilly’s Olumiant Together support page
• For LITFULO (ritlecitinib) prescriptions ONLY, visit Pfizer’s LITFULO Copay & Support Sign-up page

Tips on Applying for Insurance Reimbursement

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Insurance claims can be confusing – don’t let that stop you from getting what you need. Here are some tips for you that may help you make those claims.

Know your insurance policy and what it covers.

• An alopecia areata diagnosis is billed using the International Classification of Diseases (ICD) coding system. The latest version (ICD-10) diagnostic codes for the disease are from L63.0 to L63.9, depending on the type of alopecia areata:
• L63.0 – Alopecia totalis
• L63.1 – Alopecia universalis
• L63.2 – Ophiasis
• L63.8 – Other alopecia areata
• L63.9 – Alopecia areata, unspecified

Previously, there was only one code of 704.01 for all types of alopecia areata.

• Verify with your insurance company how your policy handles a specific treatment for alopecia areata and whether prior authorization is needed for therapy.
• Identify any copays and how much you will be expected to contribute to the cost of therapy. Be sure to check about annual limits.
• Know whether your insurance company requires “step therapy,” which means you must try and fail one therapy before the next level of therapy can be covered.

Do your homework before submitting a claim.

• Some treatments require preauthorization. Check to see if this is the case with your therapy.

Make sure your medical records are accurate.

• Keep copies of your medical records and make sure they are up to date. You have the right to receive copies of all of your medical records. Note that you can be charged a copy fee.

Include a Letter of Medical Necessity. 

Always appeal denials!

• Denials for people with alopecia areata are most often are related to the insurance company designating a treatment or therapy as:
  • Cosmetic and not medically necessary
  • Experimental or investigational in alopecia areata and prescribed as off-label use.
• Statistically, about 40% of appeals are successful, so NAAF urges you to always appeal a denial at every level.
• Prepare for denial of your claim.
• Involve your doctor in helping you respond to a denial.
• Documentation is crucial. In addition to having necessary documents that show your case meets the insurance provider’s guidelines and demonstrates medical need, be sure to:
• Maintain records of all communication with the insurance company.
• Document every time you speak or hear from a company representative.
• Record each person’s name and the date and time of the conversation.
• Note the key messages from the conversation and anything the representative said would be done or looked into.
• Familiarize yourself with your insurance company’s guidelines and deadlines for appeal. This information is usually included in the denial letter.
• If you don’t understand why you were denied, ask so you can address the insurance company’s reason(s) directly.
• If your communications with the insurance company’s Customer Service office is not satisfactory, ask for a nurse case manager or a supervisor who might be more understanding of your situation.
• If you did not previously provide a Letter of Medical Necessity, be sure to include one for the appeals process.
• When possible – to justify the cost – demonstrate that the treatment results in clinically meaningful improvement in quality of life.
• If you are still denied following the final round of appeals, contact the advocacy or patient assistance program for the company that produces the treatment. Most companies have divisions that take applications for financial assistance for their therapies.
• If you are unsuccessful with the appeal process, consider contacting your state insurance commission. You can find them here: www.naic.org/state_web_map.htm.

How to Draft an Appeal Letter

Appeal letters should be factual and to the point. Include the following information and documentation:

1. Your policy and claim numbers, employer name if your policy is through an employer, and the full name of the insured
2. The therapy or procedure for which you were denied and why the denial letter stated you were denied
3. Medical records that back up your diagnosis and medical problem that relates to the therapy in question
4. Letter of Medical Necessity
5. If the Letter of Medical Necessity is not signed by your physician, have your physician provide a letter of support that includes the reason for recommending or prescribing your therapy.
6. Two or more articles from respected medical journals backing your claim of medical necessity
7. Refer to the NAAF website as an authoritative source of medical information on alopecia areata.

Resources to Help Manage Insurance Claims

• Watch NAAFs webinar from ​​September 2022:  Navigating Prior Authorization and Insurance Appeals for Wigs, Cranial Prosthetics, and Medications in Alopecia Areata 
• Watch NAAF’s webinar from November 2022: Wigs and Insurance: How to Advocate for the Coverage You Deserve
• Download NAAF’s sample​​ Letter of Medical Necessity
• Visit the American Academy of Dermatology ​​Association’s How to Get Prior Authorization for Medical Care

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