symptoms, complaints of mechanical failure??

I called my insurance company today.  They will cover a second WLS but only if found to be medically necessary.   ie.. mechanical failure.   I guess i need to go see my Family Dr first. 

Having a BMI of 35.2 with comorbidities  is not medically necessary.... (uggg)

Anyone have an ideas on some of the complaints i can use to help the mechanical failure diagnosis along???

Hi, I have a problem too and it is called a gastro gastric fistula, in other words staple disruption, that is mechanical failure. What insurance company do you have? Carole

I have Keystone Health Plan East.  (it is a blue cross program)  Call your local Dr office that does RNY to DS surgeries and ask them what the procedure code is for the operation.  It will make it SO much easier when you call your insurance company. 

If I remember i have to code att work.. I will try to remember to post it tomorrow.    PM me if i forget and you want to know it.

LOL -- but I understand. 

My Band is a pain in the @)(&**%$@

AETNA will allow a revision if .....(1) I am a failure they will let me have RNY or DS or ....(2) my band is a failure I can also do RNY or DS, but also the Sleeve.

I want the sleeve -- so I am going in for an upper GI and hope I have some type of failure

Ha -- how many WLS patients say they want their tool to fail...........

Mechanical failure would have to be documented, usually by upper gi or endoscopy......your surgeon would then need to correlate the results of these tests and show medical necessity of revision to correct the failure.  Some of these would be rapid gastric emptying, severe dumping, fistula...but remember these must be backed up with test results for most insurance companies.

I understand the need, but be careful what you wish for in mechanical failure.  I had VBG 9 years ago, lost 100 pounds gained back almost 50, and found out I had PCOS and Epstein Barr disease.  So I thought this year I would go see about a revision, something more stringint, plus I had bad heart burn. 

I had a staple line coming un-done, had been for years, freaked out the radiologist, and a partial obstruction where the ring was.  A few more years and yeah it would have closed on me, and not sure what would have happened.  But it did make it nice because insurance agreed with the doctor and approved my surgery.  I just hope my body deals with the bypass better than it did with the first one.

That is what my BCBS told me also about the mechanical failure.  I have an enlarged pouch and stoma, rapids emptying causing severe reactive hypoglycemia, my blood sugars drop in the 20's,  I have PCOS, bulging disk, oseoarthritis in my knees and they are denying my revision. 
Good luck, I guess insurance companys would rather pay for back, knee surgery, and multiple physical therapy sessions and all sorts of other medical claims that do one and be done!

 My insurance Anthem BC/BS approved my band to an RNY because my band slipped.  Symptoms: trouble swallowing, acid reflux, and vomiting. I did have an Upper GI followed by a EGD.