[황정욱의 탈모 백과사전] Can I receive ‘actual loss coverage’ for hair loss treatment?

[파이낸셜뉴스] The Hair Loss Encyclopedia is an expert column by Hwang Jeong-wook, CEO of Mojelim, a well-known hair transplant doctor, who provides information related to hair loss and hair transplantation. He provides detailed information on hair loss self-diagnosis methods, various types of hair loss, hair transplant surgery, and hair loss treatment drugs. You can hear directly from experts.

Actual loss medical insurance is an insurance product that pays the medical expenses incurred by the subscriber when treating an illness or injury. The scope of compensation is the out-of-pocket expenses and non-benefit portion of the benefits indicated on the medical bill, excluding the amount borne by the National Health Insurance Corporation. The compensation amount is the remainder excluding the deductible within the maximum limit of 50 million won.

So, will hair loss treatment be covered by actual cost medical insurance?

Actual cost medical insurance is quite popular because it covers medical expenses not covered by national health insurance. Hair loss is generally misunderstood as not being covered by actual cost medical insurance. However, in reality, there are cases where hair loss is eligible for membership and cases where it is not. Hair loss due to disease can be covered by insurance.

If you receive outpatient hair loss treatment due to a disease, you are eligible to receive insurance benefits.

On the other hand, hair loss due to aging cannot be covered by insurance.

The standard terms and conditions of actual medical insurance stipulate that ‘compensation is provided when the insured person is hospitalized for illness or injury and receives treatment or fills a prescription.’ Actual cost medical insurance, which is a comprehensive system, clearly states in the terms and conditions that it is not covered. Diseases covered by insurance are not listed. The terms and conditions simply state, ‘Uncompensated disease: Hair loss due to aging.’

This means that hair loss due to aging is not covered by insurance. Broadly speaking, hair loss due to causes other than aging is subject to actual cost medical insurance. However, hair loss treatment for cosmetic purposes is not applicable. Treatment for simple appearance improvement cannot be claimed by insurance. Also, in reality, androgenetic alopecia, which accounts for about 80% of hair loss, is not covered by insurance.

Specifically, insurance coverage applies to cases classified as diseases. Only when it is classified as a disease is it eligible for actual medical insurance. Non-recoverable hair loss caused during chemotherapy, alopecia areata due to an autoimmune disease due to stress, seborrheic hair loss due to scalp inflammation, hair loss due to thyroid disease, etc. can be claimed as actual medical expenses. Here, compensation includes outpatient medical expenses and prescription drug expenses.

When claiming actual cost medical insurance, you must write down the disease code. If the code number for the appropriate disease item is not entered or the doctor’s opinion or medical certificate is unclear, you may be disqualified from the insurance payment review. For example, alopecia areata is almost easily handled when you file a claim with medical insurance. However, sometimes actual medical insurance claims are rejected. This may be due to a mistake in the disease classification code number or a difference in the diagnosis given by the doctor and patient.

Hair loss linked to a disease is discovered by chance and tends to progress rapidly. On the other hand, hair loss due to genes, hair loss due to aging, and hair weakening due to environmental changes progress slowly and sequentially. It is difficult to apply for actual cost medical insurance for hair loss and related skin diseases. Hair transplant, purchase of hair growth products, purchase of hair nutrients, laser treatment, antioxidant treatment, etc. are recognized as appearance improvement techniques. Hair loss in middle and old age due to age is classified as an aging phenomenon.

In general, when actual cost medical insurance is applied, medical expenses and treatment costs are settled after the fact. Insurance payment is subject to a review process.

Payment will be made after careful review of the appropriateness of entering the disease code number, whether treatment is due to the actual disease, specific treatment details, timing of insurance subscription, and characteristics of the insurance product.

During this process, the views on disease hair loss between the insured and the insurance company may not match.

Therefore, the most effective way is to minimize the burden of costs by regularly managing hair loss through consultation with a specialist from the beginning when hair loss is suspected.

/Hwang Jeong-wook, director of Mojerim Plastic Surgery

[email protected] Medical reporter Jeong Myeong-jin

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