bariartic exclusion and stil covered? (cross posted)

Does anyone know anyone that was approved for revision surgery (rny to a ds) the insurance deemed the procedure medically necessary but there was a bariatric exclusion in contract?
Thanx for the info......Yes I am still fighting this

I know you don't want to repeat stuff you already covered with me....but what is the language your surgeon is using to deem it 'medically necessary'. That generally means that there is a structural problem......malnutrition etc.......has your surgeon said that/submitted that? I think that would be key. If it can be argued that your RNY is damaged (not just ineffective in terms of weight loss) but is causing you pain or not allowing you to gain nourishment....I would think an insurer would find that compelling. Sorry to repeat....Susan

I agree with what Susan has stated.

I think if the revision was the result of a medical issue, the insurer would likely be compelled to approve.

The important thing to remember is to keep any mention of weight loss totally out of the mix.  The ONLY reason you need the revision is as a result of medical necessity due to a medical issue that has NOTHING to do with weight loss. 

Good luck!!!