How do I prove that I have been

I am in need of a revision from a SRVG to an RNY. I meet criteria A, C, & D down to the dot. I have some (3 or 4 notes in chart) medical documentation for B and 1 years worth of weight watchers weigh in cards. Does anybody know what it takes to convince BCBS of TX of substantial compliance? If I don't prove substantial compliance, does that mean I'm non-compliant? I am about 18 months post op. This is BCBS of TX revision criteria: Repeat of a Covered Bariatric Surgery Repeat of a covered bariatric surgery may be considered medically necessary only when ALL of the following criteria are met: A. For the original procedure, patient met all the screening criteria, including BMI requirements B. The patient has been substantially compliant with a prescribed nutrition and exercise program following the original surgery C. Significant complications or technical failure (i.e., break down of gastric pouch, slippage, breakage or erosion of gastric band, bowel obstruction etc.) of the bariatric surgery has occurred that required take down or revision of the original procedure that could only be addressed surgically D. Patient is requesting reinstitution of an acceptable bariatric surgical modality. A Roux-en-Y procedure following vertical banded gastroplasty or laparoscopic adjustable banded gastroplasty is considered not medically necessary for patients who have been substantially noncompliant with a prescribed nutrition and exercise program following the original procedure. Has anybody been approved for revision lately? I sent in stuff to BCBS of TX and they have requested documentation for Criteria B. I'm getting a "packet" organized. Any words of wisdom appreciated. J

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