My Empoyer's Plan vs my stoma

My employer's healthcare plan specifically states one bariatric procedure per lifetime. However, my surgeon has stated that I require a Band Over Bypass to correct a dilated stoma (staples came out of place )....  The insurance rules this BOB a second bariatric procedure not a correction to the RNY....

Has anyone had any experience appealing for an exception/waiver to the Empoyer's Plan???

 
A lot of ins co's are going to the one WLS in a lifetime and honestly, I can't blame them.  Look at the band board, you can often see someone basically explaining that they know the band has horrible results, awful stats, and lots of complications but they will get it anyway and just revise if it doesn't work.  I wouldn't want to pay for additional surgeries for someone like that either.  I think it is that population (those that knowingly get procedures they know are not likely to work) that caused ins co's to adopt the one WLS in a lifetime rule.

Sadly they have every right not to cover a revision.  Putting a band over your bypass is not a correction to the stoma, it is a band over your bypass.  Correcting the stoma, unfortunately, would be something like Stomaphyx that does not work either.

Also, if you end up self pay I certainly wouldn't get a band over your bypass, it's quite unlikely to work.