Revision help-gastric bypass

I have a date for a revison gastric by pass. However, my insurance company sent a denial for the procedure. When I called them they stated that the doctor must provide a clinical reason why the first bypass did not work. The doctor's office staff stated the reason for the revision was because the pouch was made too large. His staff suggested that contact the insurance company myself. How can I provide a clinical reason for the revision?

that makes no sense at all, while I'll admit I know nothing about revisions, how can you, as a lay person, provide any clinical information? I'd try to talk directly to the doctor, not the staff.

I had the same problem. I appealed and won. In my letter I said that the procedure did not faile because I lost 165 pounds. The Dr. will never admit it failed because of a clinical reason. That is like admitting malpractice in my opinion. I had put in my appeal that I had several endoscopies so that could have stretched it. I told them there is no way to tell why it happened. If you would like a copy of my appeal letter please email me and I will be happy to send you. I've sent to a bunch of people on the Revision message board. My Dr. said I should be a lawyer because my appeal was so good. It was overturned in only a few days. Good luck with everything.

Hello Can I ask how you all know you needed a revision ?? Thanks Rachel