Update 5 years post op

It sounds like you have checked all the boxes, so you should be able to get approval for this (particularly if the EGD shows any kind of damage from the reflux - in this case bad is good, for approval.) Have you started the appeals process? Some companies are reputed to simply deny all initial claims for bariatric surgery, and then approve upon appeal - that weeds out some of the less serious patients. I can't see how any kind of peer to peer review, or notionally impartial third party review would turn this down. Our local Kaiser routinely denies coverage for the DS (as their in-house surgeons don't know how to do it) but they lose upon state level appeal so often that they contracted with our surgeon to be their outside "network" surgeon for that; but they still routinely deny approval to make the patients jump through those hoops to get what they need.

Good luck - if they are denying coverage for these documented problems, they are likely going to be tough to get approval for simple weight gain reasons.

Have you called your insurance company to ask what their requirements are to cover a revision? Call the customer service number on the back of your card and ask for their "coverage guidelines." They can lay out exactly when they'll approve a revision, so you can see if insufficient loss is covered before submitting.