Insurance Help

Just recently found out that I have a staple line disruption. Original proximal RNY in 1990. My primary insurance company wants 2 years of clincal documentation of weight loss attempts and compliance. My PCP did follow me for a couple of months but not for two years. How can I get around this issue. My surgery has failed now it seems like I have to prove it. Any suggestions? Thanks Ginny

Staple line disruption is a medical issue. Try going at it from that route. I may not be making sense here but mine was covered because of medical necessity to correct an ulcer. Since this was 13 years Your PCP should have some documentation or were there other things you went to him for. Good Luck

Ginny, who discovered you staple line disruption? Did you have some test that showed conclusively that that is the problem? That should be enough documentation. It sounds like someone is treating this like an initial request for surgery, which it obviously is not. What I would suggest is that you find out *****views the requests such as this at your insurance company. (A medical director, perhaps?) Then write a letter addressed to that person and include copies of the doumentation. Be sure to state you are asking for a correction of a problem that occured after the initial surgical procedure was done. Good luck with this. (We had a similiar situation where a woman had her stomach stapled several years ago and then had a disruption and started to gain weight, and our company paid for a revision to RNY.)