Denied for Revision of Failed 1st Surgery

I was denied by BCBS for a revision, and if your policy on revision follows my same policy than you have a better case at getter a revision that I do!!! 

Per BCBS medical policy G-24: Repeat or Revised Bariatric Surgical Procedures (43848, 43886-43888)

Conversion of a gastric restrictive procedure without gastric bypass (e.g., vertical banded gastroplasty) to a gastric restrictive procedure with gastric bypass (e.g., for morbid obesity)            

Revision of a failed gastric restrictive procedure (e.g., restapling of dehisced vertical banded gastroplasty staple line, severe adhesions of the gastric pouch, stenosis of stoma, dilation of stoma)                                                              

A Roux-en-Y gastric bypass (43644, 43846) may be considered medically necessary for patients who have not had adequate weight loss (defined as loss of more than 50 percent of excess body weight) from vertical banded gastroplasty (43842). Since, maximal weight loss is not typically achieved until 1 to 2 years of vertical banded gastroplasty, a Roux-en-Y gastric bypass is considered not medically necessary and not covered if performed within two years of a vertical banded gastroplasty.  In addition, a Roux-en-Y gastric bypass following vertical banded gastroplasty is considered not medically necessary and not covered for patients who have been substantially noncompliant with a prescribed nutrition and exercise program following the vertical banded gastroplasty. More than one vertical banded gastroplasty or Roux-en-Y gastric bypass procedure is considered not medically necessary.                                                    

Reoperation may be required to either “take-down” or revise the original bariatric procedure.  Surgical revision or reversal (i.e., take-down) is covered for members who have complications from the primary procedure demonstrated by diagnostic study (e.g., obstruction, stricture, dilation of the gastric pouch).  A reoperation or reversal is considered not medically necessary unless the primary bariatric surgery has resulted in complications, and therefore, it is not covered.                                                 You obvioulsy have a complication from the original surgery. They denied me saying I had lost successfully and regained weight...and I hadn't...I just mailed my appeal in today. I've heard BCBS just denies to deny. So have your surgeon do the peer-to-peer review and if that doesn't work start the formal appeal process.