TML Exclusion

I have read the messages related to specifically written exclusions in insurance policies, and am becoming disheartened... My wife is in need of Open RNY, and has everything in order with the surgeon....except the insurance approval! Our TML policy clearly states "The Plan does not pay for medically necessary or non-medically necessary surgical procedures for obesity." The person we called at TML said there wasn't any point to our pre-determination request, for it will be denied. Is that the way it goes? Has anyone been successful in getting an approval within TML Insurance with such a restrictive insurance policy stated? She MUST have the surgery--it is a matter of life and death--and we will pay all of the costs ourselves if necessary, but sure would be nice if at least half of the $25K cost could get covered through the insurance. We do not want to do anything that involves a lawyer, so is it better to just give up right now and self-pay the surgery?

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