Qualifications for Revision?

Does anyone know what the weight gain qualifications are for a revision?  Is it only weight gain, or do you need other issues to go along with it?  I had my  RNY surgery 6 years ago, lost 120lbs to 135 and maintained for 3 years.  Slowly gained back about 20lbs, got pregnant but didn't gain much with that and by 2 weeks after was back where I started the pregnancy at 160, but after my daughter was born (20 months ago) I quickly gained another 35lbs to just under the 200lb mark.  We thought that my thyroid was off, but I was within what they say are normal limits, though it's on the edge.  My iron levels completely tanked after having the baby and that is when my weight went up like crazy.  I had iron infusions done and my levels are on the low end of normal but the extra weight is driving me crazy.  Right now I'm around 175 and can't get the scale to budge, despite doing everything right.  I focus on high protein, low carb meals.  I don't drink with my meals for about 30 mins before or after, usually more like an hour after I eat.  What concerns me is that I don't feel like I have any restriction, I can eat quite a bit of food so portion control is hard for me.  I get super hungry, never got hungry before and had to really remember to eat when I was supposed to.  The thought of losing 40lbs scares the heck out of me when I feel like food just goes right through my pouch.  It's almost like when I was pregnant my pouch stretched out and it just hasn't gone back.  I have an appt to follow up with my surgeon for my yearly check in in 2 weeks, but thought I would do some research before asking him about it.

It really depends on your insurance but I doubt there is an insurance company that would approve a revision just because of 30 or 40 lbs, probably not even a surgeon would do it even if you were self pay.  Hopefully when you see your surgeon you can have testing done to see if there are mechanical problems with your surgery such as a stretched out pouch or stoma.  Those aren't uncommon problems and some insurance companies will pay to have those repaired or for a revision to another surgery or for a lap band (run).  Also run from anything like Stomaphyx or the ROSE procedure.  They haven't shown any success that I have seen.
If your pouch and stoma are within normal limits then you are probably stuck watching what you eat and getting in more exercise.  Have you gone back to basics such as protein first?  My advice is to get in at least 100 grams of protein and 100 oz of fluids.  Avoid refined carbs and limit your carbs to around 50 grams or less while you are losing.  Don't mess with the 5 day pouch test, either unless you need it to detox from carbs.  Many who have regained have found the culprit has been those "bad" carbs like sugar, bread, cake, cookies, pasta and the like.  Also, don't drink things with calories except of course protein drinks.  Avoid soda, fruit juices and all that.
Good luck to you.

Also every insurance and surgery center have their own
rules and requirements.

Get an endoscopy and a CT Scan of your abdomen and your thyroid checked, those where all the things I had to do before we even discussed revision and what kind. I had initially lost 130 and then put back on 75.  I was approved in 24 hours.

Wow that's awesome that you got approved so quickly!

Your thyroid levels may be too high even though they fall within "normal range". Get a second opinion or go to an endocrinologist.

 I went to my new surgeon with a BMI below 40 and no comorbids and they basically told me my ins would not approve unless I was over 40 bmi. So basically they told me to gain more weight first (I know so stupid, but a means to an end). Once my BMI was over 40 I was approved easily. I am sure it is plan specific. Maybe call your ins company and ask. 

Thanks for your replies!  I wanted to update after my initial post, I appreciate your responses!  I saw my surgeon for my appt, explained to him my situation and he wanted to do an upper endoscopy to check the size of my stoma.  They actually do this in the office now, it's done through the nose vs. how I had it done a few years ago (had to go to the gastrointerologist, twilight sedation and done through the mouth).  They had a cancellation for the following morning at 8am so I jumped at that.  Doing it through the nose wasn't the most pleasant of experiences but the 5 minutes of torture (apparently I have a sensitive gag reflex) yielded some great shots of my extremely stretched out stoma.  My pouch was still small but my stoma was stretched way out, so basically food is just going directly into my intestine.  He is suggesting a band over bypass for me, though he does have information on a new procedure called the Apollo Stitch but he's never performed that himself.  Basically they go in and tighten the stoma but it's all done through the mouth, similiar to an upper endoscopy but you are put under general anesthesia.  This is a new procedure (not the ROSE or Stoma-Fix that have been out for awhile now) and has had good results.  He has some colleagues in the area who have done it but he hasn't himself so he would refer me out.  Insurance will definitely not cover the Apollo but it's much less expensive than having a LapBand.

I ended up calling my insurance company (BCBS) and asked what the criteria was for a revisional LapBand and they said that they didn't have any specific criteria, that it was approved on a case-by-case basis.  They do have specific requirements for a Lap Band listed, but not in a revisional situation.  The patient care coordinator at the dr. office (Erika) was kind of insistent that the insurance wouldn't cover it, but after speaking with them directly I was more hopeful that they would.  I know that with my insurance plan, things that we were told generally require some hoops to jump through have been approved without issue (my DH has had many surgeries) so I was hopeful that this could be approved.  I could take out a loan, but honestly that is not in the financial situation right now.  Reluctantly she agreed to do the insurance process, which really bothered me about the fact that she just pushed it off from the start.  I told her that I just couldn't accept that the insurance would deny it without trying first.  The person I spoke with at BCBS said that I would need to submit a letter of medical necessity from my surgeon, include copies of the testing that was done, that the letter would need to be detailed as to why I needed this procedure.  My surgeon requires more than that, a visit with him, a visit with the nutritionist (already done), a letter of recommendation from my PCP (my PCP has retired, my Ob/Gyn will hopefully be able to write this letter for me), a report from the Psych and then they'll submit it.  I also may need to go to their "back on track" program though after my meeting with the nutritionist she agrees that I'm eating all the right things and doing what I'm supposed to be doing so that may not be necessary.  I am meeting with the psych on thursday at noon, though I already spoke with her on the phone to get the ball rolling.  She's great, I worked with her before my surgery 6 years ago and said that she will write a "compelling" report for me, that she's been doing this for a long time and she's got exactly what they need to see down to a science.  I'm looking forward to talking to her on Thursday.  After I see her, I have an appt with my surgeon, and one with my OB/gyn later in that afternoon.  Thankfully they're all now in the same building!

My BMI is 30.4 so to gain up to the 40 required by most I would need to gain to 235.  Not gonna happen.  I could never do that if I tried, I've come too far to do that.  I'm hoping that the fact that my stoma is stretched way out (it's about 2.5 inches when it should be about 1/2 inch) and that it's a psychological issue with the fact that I just never feel full, never feel satisfied and all that comes with that will be persuasive enough to them.  I've been doing it for almost 2 years now and I just am scared at the long term.  I've been slowly gaining and eventually could end up where my BMI qualifies.  My dr. is really of the camp that Obesity is a disease, and one that will be battled for lifetime.  He absolutely supports me for a BOB, it's going to be whether or not insurance will cover it.  Fingers crossed.  I would love to tell Erika "told you so" with insurance aproval.

I hear what you are saying!  Going thru it right now.  Mine requires the same for revision as new, which is stupid on their part.  I have to have 35 plus co-morbs. I started at 45 bmi.  I was down to 32 but, since the band came out I'm up to ~35 now with cloths, heavy shoes and now its colder I can wear heavier cloths.