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well barix called me today and she said that my insurance doesn't have a benefit that covers that procedure but if i wanted to do the advance payment option of 25,500 up front i could do that . has anyone had this happen to them and what steps can you take to try to get the insurance to go for it if any ?

Tommy, Myself and a few others have had similar experiences with Barix. I had my consult in Feb. 04. Before I even began any of this process, I asked questions such as, do you accept our insurance and if I am denied will you help me to be approved. The answer was always an emphatic YES! I went to the consult, paid the fee and then proceeded to have the pre-op tests done (stress test and heart echo). Failed the stress test which lead to a heart cath to find out it was a false positive, thank goodness. But, this entire time, my emotions are really high thinking its ok cause the eventual outcome will be a benefit to my overall health. In late April the insurance department at Barix, despite me begging them to submit, flat out refused to submit it stating I would be denied. My husband's company had an exclusion-not totally impossible to meet but according to Barix would be enough to deny me. I spoke not only with the human rescources department at my husband's employer but also with Aetna and both strongly suggested to submit just to get a denial so I can appeal, which is where both said underlying cir****tances with my health could possible get me approved. Barix refused so I requested my records and made an appointment with Dr. Curry in Cincinnati. Dr. Curry's people submitted my request in mid-June. I've not heard a word from the insurance company yet but at least, I did get it submitted and now I can fight if I need to to get approved. My suggestion to you would be to contact your insurance company yourself and get it in writing what they say about it or what is required. There are a couple of attornies who will help if there are exclusions in the policy. You might need to start working with them. Never give up-never surrender! Beth

Hi Tommie. I have to echo Beth's respone!!! (my hubby and Beth's hubby have the same employer & insurance) I had the exact same thing happen to me with Barix. I had a consult with Barix on May 3, 2004. They ASSURED me that everything would be taken care of by my insurance company. NO PROBLEM!!! I was 'flying high", so happy that I would soon be rid of all of this weight. Then, after sending them everything they asked for (paperwork) Barix would not even submit my package. And as Beth said ...if you do not have a paper trail, you can not fight the insurance and appeal if rejected. I felt as if Barix gave me false hope. Don't get me wrong, I am sure the doctors and facilities at Barix are top rate... I just felt as if the insurance staff and other staff give some of us false hope... If Barix knows from the get-go that one's insurance will not cover the procedure, they should TELL us!!! COME ON, JUST BE HONEST WITH US, BARIX!!!!... Instead of having us waste our time and money (the consultation fee!!!) and travel to the other side of the state to then have our hopes dashed... Isn't it a shame that even though my hubby has a great job, I am not fortunate enough to have 25K in my back pocket...LOL (who does???) I am on the self pay road right now, and hopefully, will be seeing Dr Curry in the near future. Don't give up the fight. HUGS ~Deb

I had called barix too and said what company I have for ins and they said I wouldn't be covered and said the only was was the upfront also. They wouldn't even talk to me unless I said I'd pay upfront. I haven't had my surgery yet, but I've met with Dr. Fallang and they will do just about anything they can to help you get approved. They tell you anything they can that you would need and if there are anyways around it. I have Anthem and I had to write a letter of necessity, and have a nutritionist eval. and a pshyc. eval. to send in for approval.

Hi, Tommie... Don't give up hope. I had also called Barix and was told I'd have to pay for it myself. Then I found out there are OTHER doctors/hospitals that do the same surgery! (duh on me, eh?) So now, I'm waiting to attend a seminar in hopes of having Dr. Kerlakian as my surgeon. He's in my insurance network, performs surgery at an in-network hospital and VOILA, does bariatric surgery! Just keep checking things out! Sheil

that is what i was wondering about see i do have some doctors that are in network and i'm certain do it at the hospital that is in network now my question is if the doctors and the hospital are in network would they cover this then ? this is really driving me crazy just when ya think ya take a step forward it's like taking 20 back for me if ya know any information about that i would really appreciate it thanks so much take care and good luck

Just an FYI - the office staff you see at Barix when you see the doc are not the ones who submit your info to insurance. They send it on to an office in Michigan who submits it to insurance. I also had Aetna and the surgery was a covered benefit but was considered "out of network" since Barix doesn't participate in many (if any) insurance programs as an "in network" provider. So, Aetna approved my surgery, but I knew I was risking the possibility of thousands of dollars out of my pocket since it was out of network (I would be reponsible for the first 1000, plus my 30% portion up to 2500 then I would also be responsible for paying the difference between what was billed and what insurance deemed to be "reasonable & customary" which could be huge). Luckily, Aetna ended up paying for all but 1,500 of a 46,000 bill which figures out to be about 97% of the bill being paid by Aetna. I don't know why they paid so much - was it because of medical necessity?? I know many insurances will cover items deemed as medically necessary at the in-network rates even if you use out-of-network physicians/facilities. If I were you, I'd call the office in Michigan and bug them to submit for you.