technical failure?

Rhonda S.
on 11/10/08 7:16 am - Bensalem, PA

I had a VBG back in 1987.  I initially lost weight and then regained over a 3 year period. I have lost and gained many pounds since then. I am interested in a revision from the VBG to RYB. After a upper endoscopy the surgeon discovered a total disruption of the staple line. I haven't experienced any restriction in eating since the first six or seven months after surgery.  My insurance will cover revisions for technical failures and complications.   Does anybody know if disruption of the staple line is considered 'technical failure 'for insurance purposes'- I have BC/BS

LosingSally
on 11/13/08 4:55 am
Yes it is a technical failure. Nontechnical failures are when a person out-eats their surgery.  In your case, the staple line failed and you have no restriction.
Now if you didn't have the staple line fail and open your pouch to your big remnant stomach, then it would be considered personal failure. See what I mean?  I would get a letter of medical necessity stating mechanical failure from a surgeon.
Rhonda S.
on 11/13/08 5:43 am - Bensalem, PA
Thanks for the info.  I see the surgeon for my post-endoscopy follow up to find out if and what kind of revision could be done.
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