Empire Blue 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?

I'm not sure - I have a slippage of my band and the surgeon told me that will be covered, but I'm trying not to get my hopes up.  I don't care too much for these lap bands.

I'm actually  in the process of switching from Lap Band to RNY and I have Empire BC/BS.  First off alittle history...banded 1/9/04....started having TERRIBLE reflux back in March 07...didn't say anything to my surgeon until it became so bad that I couldn't even drink water without having pain....had an upper GI series on 6/1 which confirmed the slip and reflux.....had an endoscopy 6/22 which showed I have esophogitis and now a nice new hiatal hernia and some erosion from my band. Paperwork went in for the revision surgery 6/26...denied 6/27...appealed 6/28 and told all I need to do is have another Psychological Evaluation and Nutritional Counceling and my surgery will be APPROVED!! So that is where I stand now.  So next week I have both appointments schedualed and the appeals nurse gave me her private fax # so I can fax everthing over to her myself.  I'm going to miss my band, but I don't want to gain all the weight back that I have lost.  It's bad enough that I've gained back 26 lbs and I'm very depressed about that :( But my new future is looking bright :)

I also have bcbs and my band has caused horrible reflux. So I had an endoscopy last week. BCBS originally said I had to have six months of weigh****chers, etc,but I beleive it is now medically necessary. However, I got a call from my doctor and they said BCBS is requesting a psych evaluation. That is scheduled for tomorrow, so hopefully that is all. If so I will have band removed and get RNY.