revision deemed med necessary but contract exclusion

 Anyone ever get covered for this scenario- the insurance med board found the revision from rny to ds to be med necessary but your employer contract excluded bariatric surgery and u didn't know it?

It sure happens! Your company has obviously opted OUT of bariatric surgeries...HOW shameful! They either are not informed at HOW MUCH it will save them in the long term on health care costs OR they don't care.
Sorry.

I have Bariatric surgery exclusion clause.  How can I fight it?  Obesity law or something else?  I am lost  Thank you for your input.

You're screwed. There's no way to fight an exclusion clause.

It happens all the time!

Also some insurance companies that do cover bariatrics and now adding a "one WLS per lifetime" stipulation to their policies.

I know a lot of companies exclude WLS but I've never heard of anyone getting around it for any reason. I have heard of people changing jobs in order to get it covered.

IF your initial surgery has rendered you seriously ill (structural problems that prevent you from functioning) you may have a chance. If the issue is failed weight loss.......it is a much harder thing to get approved. Can you share the nature of the medical necessity? Susan

Sleep apnea, weight gain, depression, borderline diabetic. 

Well.......unfortunately those are obesity related co-morbidities......so it would likely be deemed a failed weight loss. While they are the very reasons we have WLS - to hopefully reverse both our risk and our outcomes - a revision is much harder to have approved even if the insurer has a WLS clause. The appearance of more 'one WLS per lifetime" is a response to people seeking revision. How long ago did you have your RNY? Starting/ending BMI? Did you have sleep apnea and the other comorbidities pre RNY? Good luck with your case. Hopefully your surgeon is looking at all possibilities. Susan

Wow Chocolate, you've been at this for such a long time.  I am so sorry that you just found out that your insurance does not cover bariatric surgery.  That sucks and to be honest I believe that you can do nothing about it, an exclusion is an exclusion! Man oh man it sucks!

Ask Diana over at the DS forum about this or do a search here on OH.  I've seen like scenarios presented here before.

Good Luck.