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FINDING A DOCTOR

Treatment options are best discussed with the doctor who made the diagnosis or other qualified medical professional. Your healthcare provider is likely to be your best source of medical information.

If you need help finding a health care provider in your area, you can visit The American Academy of Dermatology's 'Find a Dermatologist' website. You can also contact the NAAF office by phone, 415-472-3780, or email. NAAF keeps a list of medical professionals in the U.S. who are experienced in diagnosing and treating alopecia areata. 

For help finding a pediatric dermatology specialist for your child, you can also use the Find a Pediatric Dermatologist Search provided by the Society for Pediatric Dermatology.

INSURANCE REIMBURSEMENT

Obtaining insurance coverage for the medical treatments for alopecia areata can present a challenge because prior authorization from the insurer is usually required and insurance denials are not uncommon.

There is now an FDA-approved treatment for severe alopecia areata, the oral JAK inhibitor, Olumiant (baricitinib). Since it will take some time for insurers to add this medication to their list of covered prescription drugs, the process of getting insurance coverage will likely take multiple steps, including seeking prior authorization and potentially appealing any insurance denials.

In addition, some treatments for alopecia areata are used off-label, that is they are used in a way that is not included on the approved drug label. This includes intralesional corticosteroid injections, a common treatment for mild alopecia areata. Prescriptions for off-label medications may also require these extra steps when seeking insurance coverage.

Work with your prescribing physician’s office to determine the steps needed to get coverage from your insurance plan.

Here are some resources to help with this process:

Tips on Applying for Insurance Reimbursement
1. Know your insurance policy and what it covers.

  • Diagnosis is billed using the International Classification of Diseases (ICD) coding system. The latest version (ICD-10) diagnostic codes for alopecia areata are from L63.0 to L63.9 depending on the type of alopecia areata. In the ICD-9 version, there was only one code of 704.01 for all types of alopecia areata.
  • For wig reimbursement, Healthcare Common Procedure Coding System (HCPCS), administered by the Centers for Medicare and Medicaid Services (CMS) in cooperation with other third party payers, are used to report supplies, equipment, and devices provided to patients. The HCPCS billing codes for wigs are S8095 and A9282.
  • Investigate how your policy handles a specific treatment and whether prior authorization is needed for a therapy.
  • Understand any copays and how much you will be expected to contribute to the cost of a therapy.
  • 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.

2. Do your homework before submitting a claim.

  • Some treatments require preauthorization. Be aware whether this is the case with your therapy.

3. Make sure your medical records are accurate.

  • Maintain copies of your medical records. You have the right to receive copies of all of your medical records. Note that you can be charged a copy fee.

4. Include a Letter of Medical Necessity. Contact NAAF for a sample letter.

5. Always appeal denials!

  • Denials for alopecia areata patients most often are attributed to the insurance company designating a therapy as cosmetic, not medically necessary, and/or being 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 making sure you have the necessary documentation showing that your case meets the insurance provider’s guidelines and demonstrates medical need, maintain records of your communication with the insurance company. Document every time you speak or hear from a company representative; Record the person’s name, date, time and key messages from the conversation.
  • Familiarize yourself with your insurance company’s guidelines and deadlines for appeal. This information is usually included in the denial letter.
  • Understand why you were denied, so you can address the insurance company’s reason(s) directly.
  • If you are communicating with the Customer Service office of the insurance company and are dissatisfied with the response, ask for a Nurse Case Manager or a Supervisor who might be more understanding of your situation.
  • If you did not previously include a Letter of Medical Necessity, make sure you include one for the appeals process.
  • When possible, demonstrate that a treatment results in clinically meaningful improvement in quality of life to justify costs. 
  • If you are still denied following the final round of appeals for a treatment, 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
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.