yeah, you're not the only one who wants to scream, and with good reason. I have had experience with out-of-pocket services. You can have it, but you will also end up paying for about 80% of the total bill yourself. You can write a letter of medical necessity and sometimes, because of his expertise and if they're not another comparable surgeon for your condition (if the 1st doctors writes a letter stating he's not qualified for your situation, and he's within your group, they may allow it under your HMO. Don't hold your breath though. They really don't have to. I fought the system and I paid is all I'll say. Maybe there's another doctor within your HMO. A longshot, but try to talk the surgeon's office into joining your HMO. It's a contract between the provider and insurance co. Aetna is good to pay, just by their rules. You probably have a policy there that will explain a lot more than I can about your ins. I ended up contacting my state representative and the Department of Insurance. I made a lot of noise, but in the end I still paid.

It's not fair how insurance companies, or the lack of coverage, can make you suffer too.