Has anyone been denied by Healthlink Open Access III and then been approved?

I have been denied 3x. I had gastric bypass 22 years ago...I have a fistula now and I empty into both sides of my stomach...which is causing me to gain weight...My doctor wants to do a open RNY, but my insurance policy has an exclusion for it, even if it has a fistula...can anyone help? My HR person said "get a lawyer" or "go on long term disability"...Please offer some advice...Thanks

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