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Post date: January 18 2002

Empire Bc/bs Agrees To Cover Wigs For Hair Loss Disease Patients

Attorney General Spitzer today announced an agreement with Empire Blue Cross and Blue Shield regarding coverage for the cost of wigs for Empire members who lost their hair as a result of alopecia and whose contracts provide coverage for prosthetics.

"It is only fair that Empire pay these claims," said Attorney General Spitzer. "Empire covers the cost of wigs for cancer patients who lose their hair during chemotherapy. Alopecia victims deserve the same coverage."

The Attorney General's Health Care Bureau received a complaint regarding a 9-year old girl from Wallkill, Ulster County, suffering from alopecia areata, a disease that typically results in hair loss and, according to the National Alopecia Areata Foundation, affects more than 4 million Americans. The girl's parents sought coverage from Empire for the cost of a wig, or cranial prosthetic, to replace her hair lost as a result of alopecia.

Empire had denied coverage, asserting that the wig was "cosmetic" not "medical" under the terms of their contract. Empire also stated that it provided coverage for the costs of wigs for cancer patients undergoing chemotherapy or radiation, but not for individuals who lost their hair for any other reason.

In the course of investigating the complaint, the Attorney General discovered that Empire had already lost a lawsuit involving similar facts and similar policy language. In that case, the court found that the cost of a wig for an Empire member with alopecia areata should be covered under the terms of the policy.

Following the intervention of the Attorney General, Empire agreed to:
  • Cover the cost of the girl's wig under the terms of her contract;
  • Reimburse, under the terms of their contracts, several other Empire members with alopecia whose requests for wigs were similarly denied;
  • Cover all future claims for wigs for members who suffer alopecia areata and whose contracts with Empire provide coverage for prosthetics; and,
  • Include in Empire's next member newsletter notification that Empire will be covering wig claims for individuals suffering alopecia areata as well as cancer patients receiving chemotherapy or radiation.
Empire serves approximately 4 million people in New York State.

Alopecia is caused by a defect of the immune system in which white blood cells mistakenly attack hair follicles. Alopecia typically starts in childhood with one or more small, round, smooth bald patches on the scalp and can progress to total hair loss. The disease affects both males and females of all races. It is not life threatening.

This case was handled by Assistant Attorney General John Powell under the supervision of Health Care Bureau Albany Section Chief Troy Oechsner and Health Care Bureau Chief Joe Baker.

Consumers may contact the Health Care Bureau's toll-free hotline at (800) 771-7755 (option #3 on the automated voice menu).