x-post I'm approved
I prevailed at a first level grievance appeal for a revision from a 22 year old VBG to a RNY. God is good - I was very disappointed when I got the first denial - very, very disappointed, but appealed the decision the same day and sent my letter the next. WLS revision was not excluded under my policy but it did need to be medically necessary and not solely due to weight regain. My VBG [the old stomach stapling] failed God knows when - the surgeon found a complete rupture of the staple line, band erosion and mesh in my stomach wall. I have never been so happy to have something wrong with me as the day of my endoscopy - cause I knew I had a snowball's chance in hell of coverage if there had been no technical or mechanical failure of the previous procedure. I am grateful for this second chance. I'm older, wiser, been around the block with the weight ever so many more times than I was the first time. [ I was 24]. I had blamed myself for a long time about this - but I discovered the reason VBG's are rarely done in the US anymore is because of its high failure rate. I am grateful tor this second chance, probably last chance, and I will not screw up.