Where to go from here. A little confused? Atena Ppo-open Choice

I am in the process of trying to get an appt. with a Dr. in Pittsburgh for laproscopic gastric surgery. I got a call from the Drs. office requesting that I call my insurance company to see if my Dr. is in the "network". I found out the unfortunately he isn't but the hopital he does the surgery is in the network. I was told they do cover the insurance if it is "medically necessary." I was also told since I have an open choice policy I have a $300 deductable & am responsible for 30% which is about $7,000. Which don't get me wrong is better than nothing. So I called the Drs. office back & told them what I had found out. She asked me if I still wanted to go through with the appt. I told her yes. She said that they will put through a request to my insurance co. for this & will note the account I okayed it & am aware of the costs. Now I'm just a little confused. The insurance company said they will cover it if it medically mecessary. The Dr. hasn't even see me yet. So how can they send in an insurance claim with out any back up for medically necessary??? Please if someone can explain the insurance mombo jumbo to me. If I don't have to pay $7,000 that would be nice. I asked the office at the Drs. office if there was anything that can be done & she said no. So what can I or should I do now. Please feel free to email me. Thanks for you help!

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