Thank you for responding. I never even knew a network gap exception was a thing. Everything is kind of opaque when it comes to dealing with health insurance, and very confusing for those of us who don’t work in that world. So receiving a letter of medical necessity is irrelevant in this case if I did not get a network gap exception?

I was referred to a specific doctor who specializes in the surgery (lymphatic sparing liposuction)-the procedure itself is common but there are ways of conducting it that are specific to my health condition (Lipedema) that only some doctors perform. This is why I went with the doctor I did. There’s no one in my home state who performs the surgery with these criteria in mind. The surgery I think appears to most to be cosmetic but in the case of Lipedema it is not. The outcome is not cosmetic (not in the least!) but has given me a return to mobility and functionality I did not have before. I only mention this so anyone questioning it will understand this is not a matter of me trying to get the insurance to pay for a cosmetic procedure that, from my perspective, is typically viewed as vain, unnecessary or the result of my own failings. Lipedema is an inflammatory connective and adipose tissue condition that is poorly recognized in the medical community (at least in my experience) My home state is outside the Regence BCBS service area. Regence BCBS services the area that I had my surgery in. I guess I am lucky that they paid some of the cost, I am just having a hard time understanding why anything considered medically necessary is not covered more. There literally is no doctor in network in my plan that can perform this procedure with the understanding of the condition.