Question:
staple line disruption

how did you get this past your insurance conpany to pay for this. My insurance say 1 surgury for weight loss, but will pay for com. said no other com but staple line not med necessary to fix will not cover    — hansonsb (posted on August 2, 2006)

August 2, 2006
I'm sorry but this is such broken english that I don't understand the question. Could you please repost the question? My insurance covered the RnY Surgery with no questions.
   — [Deactivated Member]

August 2, 2006
Your profile indicates that you had weight loss surgery in 1993 and now have a staple line disruption that is causing you pain and infection. If that is the case, it would seem as if your surgery is medically necessary. You need to work with your surgeon to code the procedure accurately as the staple line disruption is not for weight loss (even though it might be) but is, instead, to fix a long-term complication from 1993's procedure.
   — SteveColarossi

August 3, 2006
Yes I agree with Steve, this is 13 years later. Even if this is the incision line from the WLS, I don't believe this problem was a result of the WLS. And even if it was as mine was within a month of my RNY. Everything should still be covered. I have a Home Care Nurse coming everyday to Change my wound because it needs to heal from inside outward and thus needs wound packing. Get your PCP & Surgeon on the same line. To report the right codes. Good Luck.
   — Michael Eak

August 3, 2006
My insurance paid based on it being simply a repair to a WLS that had already been successful. They did not consider it a new surgery, so I didn't have to re-qualify (thank goodness!) You may have to write your own letter reminding them of your co-morbs and the penalty THEY will pay if you regain your wt, then have your surgeon write a similar letter in "doctorese". Or ask on the Grad list where so many of us have been revised. http://groups.yahoo.com/group/Graduate-OSSG
   — vitalady

August 4, 2006
If your problem is causing infection and pain, then it is medically necessary, and your doctor should send a letter to that effect to your insurance sompany.
   — Novashannon