Question:
DENIAL BECAUSE OF NO DOC. REFERRAL

BARIX SAYS I AM A GOOD CANIDATE. BUT INS. WANTS ME DIET FOR 6 MO. BEFORE APPROVAL BECAUSE THEY SAY I HAVE NO MEDICAL NECCESSITY. I FEEL I HAVE A MEDICAL NECCESSITY. I CALLED INS. DEPT. AT BARIX AND THEY SAID I MUST DO THE 6 MO. AND GET A PHYS. EVALUATION. I RECEIVED A LETTER FROM MY INS. CO. THAT SAID THEY WOULD REVIEW MY CLAIM IF I HAD MORE INFO. FOR MY CLAIM. BARIX INS. IS INSISTING THAT THEY WOULD NOT SEND MY CLAIM THROUGH UNTIL AFTER THE 6 MO.ALMOST SOUNDS LIKE THEY DO NOT WANT ME TO HAVE THE SURGERY. SINCERELY, PAM EGGLESTON    — pamela E. (posted on June 7, 2004)

June 7, 2004
What does your insurance company require? You say your insurance company wants you to diet for 6 months..If that's the case, then it's likely that Barix knows that your insurance will deny you without the documented 6 month diet and they don't want to "waste" a try at approval. You only have so many applications/appeals before you have to start the whole procedure over again and maybe they just want to make sure that you will meet your insurance companies criteria before submitting for approval. Get in writing from your insurance company exactly what they require in order to approve the surgery and go from there. Good Luck.
   — Carolyn M.

June 7, 2004
Hi Pam, A lot of insurances are requiring the 6mo of recent diet history now (from what my suregeons office told me). What I did was put together a comprehensive chart of all of the diets of been on, how long they lasted and how much weight I lost and eventually gained back. I did have several supervised diets listed, but the most recent one was a year prior. I also inlcuded gym membership, and other exercise attempts. The other thing is that sometimes you just can't get around the requirement, so get on a doc supervised diet right away. I know how frustrating that sounds...if you could lose weight on a diet you wouldn't be here...but we have to do what we have to do to get approved. Good luck to you!
   — Rachelq

June 7, 2004
Start a doctor supervised diet ASAP..I KNOW too well, once we decide to have the surgery we want it , yesturday. Doesnt work that way. The 6 month supervised diet helped me alot to relearn how to eat actually. I saw a nutrionalist during this time once a month and behavioral therapist every couple weeks and I am doing great post op. I wish you the best of luck and I wish there was a magic pill or magic way to help but there really isnt.
   — Kathy S.

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