Excluded-Unless Medically Necessary???

Ok, I finally called my insurance comp, BCBSNJ and was told it was "excluded unless it was medically necessary". She told me I needed a predetermination letter by my PCP. I have a 48.1 BMI with several comorbidities including Type 2 Diabetes. The medically necessary part is definitely there. What worries me is the "excluded unless it was medically necessary" part. I have read all around my insurance book. I didn't see anything about WLS. Even in the exclusions section.
Has anyone come across this situation or verbiage in your insurance book? If so, were you approved?

Thanks,
Gina

The conditions you list certainly fall under the typical concept of 'medically necessary'. If the term "Morbid Obesity" means ANYTHING, it includes factors such as high blood pressure, diabetes, and a hand full of other common problems.

The carriers have to make it look like they aren't just giving WLS to 'everybody'. A little chat with your PCP to secure his support and a letter will help also.

PS: my internist rather chuckled and asked "Which of the 5 conditions YOU have do they want as justification?".....