me again, help?

Today in the mail, I got my husbands health and welfare fund and summary plan description booklet, effective august 1, 2004, and nowhere in this booklet does it even mention obesity or surgery for it. My husband has teamsters local 710, and for this surgery I was told by their union hall to submit everything for this surgery to medcare, and they submit it for approval or denial to their board. And this is what I did. I was denied, medcare said I did not have a BMI of 40 and or am not 100 lbs overweight. How did they decide this? It is not in the plan description? And I have not received a letter stating why I was denied. Our medical insurance is with blue cross blue shield of illinois. Are they to follow the plan description for the international brotherhood of teamsters 710 booklet , or whatever blue cross blue shield says.

Hi Elizabeth, I'm not quite sure I understand what you are asking, but I'll give it a shot anyways... According to your profile, your BMI is 35.5 which is below the 40 that medcare requires. I have BCBS of GA and our plan requirements are BMI of 30 - 35 with co-morbidities or > 40 with or without co-morbidities. How they establish their guidelines are arbitrary and we can't really do anything to change that. Perhaps you should call medcare and find out if there is a lower BMI limit since you have co-morbs...I know you said you've been denied already, but it never hurts to ask if there is some more supporting information that you can provide that will get your case re-assessed. OK...I just read your post again and am even more confused (are you dealing with 3 insurance companies or 1?)... Bottom line, call your insurance company and just keep asking for higher levels of management until someone tells you exactly why you were denied and what (if anything) you can do to get approved. Furthermore, find out if your insurance company plans on dropping this coverage altogether in the near future...if so, when. Finally, Roberta Apte (who happens to frequent this board) was able to help me figure out where to start towards resolving my insurance issues. Good Luck