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INSURANCE REIMBURSEMENT
INSURANCE REIMBURSEMENT TERMS & CONDITIONS
Last Updated: 2025
By requesting a medical receipt, submitting insurance information, or pursuing insurance reimbursement through Caring & Comfort (including when Caring & Comfort submits a claim on your behalf), you acknowledge and agree to the following terms:
1. Insurance Coverage Limitations
Insurance coverage for cranial prostheses varies by plan and is determined solely by the insurer. Even when a wig appears to be “covered” or “fully covered,” reimbursement may be capped, partially approved, delayed, or denied based on plan limitations, benefit maximums, exclusions, medical necessity determinations, or insurer discretion.
Caring & Comfort does not guarantee coverage, approval, or reimbursement amounts.
2. Client Financial Responsibility for Custom Work
You acknowledge that the wig provided is a custom medical product created specifically for you. You agree that you are financially responsible for all amounts not paid by insurance, including but not limited to:
- Any portion of the total cost exceeding insurance reimbursement
- Customization, upgrades, or elective features (including color, density, length, or construction method)
- Professional services such as consultations, fittings, styling, adjustments, or accessories
Insurance reimbursement is a contribution, not a price determination. Any unpaid balance remains your responsibility.
3. Prepayment, Insurance Reimbursement & Refunds
Any payment made prior to insurance billing is a prepayment for custom services, labor, and materials, not a guarantee of insurance reimbursement.
If insurance reimbursement is approved and received, it will be applied to your account. Any overpayment will be refunded within 30 days of receipt. If insurance reimbursement is partial or denied, prepaid amounts may be retained for custom work performed and are not refundable, and any remaining balance remains your responsibility.
4. Deposits, Production & Acceptance of Custom Work
If a deposit is made in lieu of full payment, you acknowledge that once production, customization, or allocation of materials begins, the order becomes non-cancelable. Deposits are applied toward custom work and may become non-refundable once production has begun due to the medical and customized nature of the product.
Once the wig has been released, worn, or used, it is considered accepted and may not be returned or exchanged based on insurance reimbursement outcome.
5. Option to Change Prior to Use
Prior to wearing the wig, you may request to cancel the insurance claim or switch to a lower-cost, insurance-aligned option, subject to any custom work already performed. Once the wig has been worn, this option is no longer available.
6. Claim Submission & Client Responsibilities
Claims may be submitted by you or with Caring & Comfort’s assistance as a courtesy. Regardless of who submits the claim, you remain responsible for:
- Providing accurate and complete information
- Responding to insurer requests or inquiries
- Following up directly with your insurance provider
Caring & Comfort is not responsible for claim delays, denials, underpayments, or insurer determinations.
7. No Guarantee of Insurance Approval
All coverage and reimbursement decisions are made exclusively by the insurer. Caring & Comfort does not control or guarantee approval status, eligibility determinations, reimbursement amounts, processing timelines, or appeal outcomes.
8. Acceptance of Terms
By submitting insurance information, requesting a medical receipt, or pursuing insurance reimbursement through Caring & Comfort, you confirm that you have reviewed and understand these Terms & Conditions and agree that you remain financially responsible for all amounts not paid by insurance, particularly where custom work has been performed.
