Aetna_ Excluded Weight loss surgeries UNLESS HMO APPROVED.

So my insurance Aetna HMO was excluded with no hope and now has 'unless HMO approved' tagged at the end of the sentence.  I would guess they would grant surgery as a medical necessity, but in those cir****tances would you still have to go through all the normal requirements or be able to just bypass with letters of medical necessities.

     I feel I have a strong chance of getting an approval.   I am 28 living with sleep apnea, have been using a CPAP for a few years, and as of August, having a DVT(Blood Clot) in my Right leg still on coumadin/lovenox regiment with PT/INR testings.  Also have pain with knees and have x-rays of bilateral arthritis.  Nothing but gyno issues, no longer having periods(not expecting), which is better than my periods of floodings.  I have a gammet more of issues reflux included. 

     Just wanting to see if anyone has Aetna with exclusion unless HMO approved and how it went. 

            I am going next Weds to an information session where I am sure they can explain all the insurance dealings.  Hoping for Duodenal Switch surgery...I really don't want to be 350 lbs.