My health insurance has an exclusion for weight loss surgery and any complications of such procedures. Seven years after my weight loss surgery I have developed a grossly large stomach pouch (500 cc compared to 30 cc) It has not affected my weight loss as my surgery was successful. However, it does cause reflux and I have chronic burping and belching almost constantly. I have test that prove this diagnosis.

The surgeon I was referred to is a pioneer in weight loss surgery and he told me it is a medically necessary operation. What do you think my chances are of getting an approval from my insurance company. The surgeon is out of network but I am willing to pay the $6,000 deductible and 20% copay. They do not have anyone in network who is experienced in this type of revision that I would risk my life to save a few thousand dollars.

What you apparently have is a complication of weight loss surgery and as you say, your policy excludes complications. What makes you think they will reverse their policy exclusions?

If in the medical notes, anywhere, it shows this is caused by the weight loss, then it will not be covered.

Also you should submit this for pre approval, to be sure