Sleeve Technical Failure?

Hi everyone! I have a question that maybe someone can answer. What is considered a technical sleeve failure?? My insurance policy is below:

I was sleeved in 2011. I lost about 70 lbs but was still at 165lbs and only 5?0. I slowly gained weight and by 2015 I was back at 190lbs. My HW was 240. I got pregnant in 2016 and gained the rest back. I have been trying to lose but i keep gaining the same 10-15 lbs. i started the process of being revised to RNY. My upper GI showed moderate reflu. I?m concerned because my mom has Barrett?s esophagus and I believe it?s hereditary. I also have sleep apnea and depression because of the weight. I?m scheduled to have an EGD in July and am hoping it shows something that justifies a revision. I haven?t had any restriction since about 7 mos post op. I can eat pre surgery quantities. My dr believe my sleeve Is completely dilated.

Fortreatmentofobesity,exceptforsurgicaltreatmentofobesitywhenthePlan (a) determines the surgery is Medically Necessary; and (b) the surgery is limited to one surgical procedure per lifetime regardless of whether such procedure was covered by the Plan or another Plan. Any new or different obesity surgery, revisions, repeat, or reversal of any previous surgery are not covered. The exclusion of coverage for a repeat, reversal or revision of a previous obesity surgery does not apply when the procedure results in technical failure or when the procedure is required to treat complications, which if left untreated, would result in endangering the health of the Covered Person.

I have seen people successfully revise from VSG to RNY due to GERD.

I doubt your sleeve has stretched as much as you think it has. Sadly many people gain all of their weight back after WLS. It all comes down to leaning good habits and sticking to them. No excuses.

Good luck.

I was sleeved as well and my diagnosis is a Intussusception in my stomach and intestine. My doctor stated that it was caused from the sleeve. I am currently in the process of appealing my insurance. Not saying its going to work, but this is a "complication" that can happen overtime. This is also a condition that individuals can have without a history of bariatric surgery. Also, like previously stated, GERD is also a condition that tin the long run, can cause cancer in the esophagus. Maybe you can get approval through that. I also have esophageal spasms due to my GERD. They are very painful and will cause narrowing of the esophagus.

I hope you are successful with the approval of surgery. Good luck!