Empire BC/BS Revision Surgery???

Has anyone dealt with the clause "there must be documentation of a failure secondary to a surgical complication such as fistula, obstruction or disruption of a suture/staple line"? What do they mean? Does it have to be a physical problem like a malfunction of the product or the actual surgery? I have horrible GERD and aspiration whenever I get close to enough restriction and have to be totally unfilled. The Band simply won't work for me! Has anyone got a clue on if this situation will be covered?

Yes, it sounds like a revision will only be covered if there is a complication with the band. However, I'm wondering why the GERD wouldn't be considered a complication? It sounds like you'll need to appeal and perhaps try to arrange a discussion with BCBS and your doctor to discuss the complications. They may not consider GERD to be a sufficient enough complication, and it might help if your doctor can let them know how severe it is. Also, you should investigate why the GERD is so bad--has the band slipped? Because if so, that would definitely be grounds for a revision.  Good luck!

Hay Gary, Is there any chance of getig this copy you mentioned? Can you post it here? Can you email it? I was denied and am now in appeals. Thanks!

I just wrote an article for the Obesity Action Coallition, let me reprint it and sticky it.  It's on revisions.

Gary, Where can I get a copy of that article. Thanks Leslie