Dynamic Accident Lawyers: Bad Faith Lawsuit: Blue Shield of California Denied Necessary Boob Job

Blue Shield of California has been hit with a putative bad faith insurance lawsuit over claims that the insurance provider refused to pay for reconstructive surgery that would allow a patient to return to a “normal appearance.”

Plaintiff Lisa Burton filed the Blue Shield of California class action lawsuit after being denied coverage for a mammoplasty procedure (reconstructive breast surgery) that would allow her to return to a natural appearance based on claims that the surgery was not deemed “medically necessary.”

According to the Blue Shield of California class action lawsuit, Burton suffered from a medical condition that required the breast surgery yet she was allegedly denied insurance in violation of California law.

Burton claims that California’s reconstructive surgery law requires insurance plans to cover physical deformity surgeries that either resolve a functional problem or create a normal appearance.

The bad faith insurance lawsuit states that this law regarding reconstructive surgeries is important because patients are allowed to receive medical procedures that help them appear “normal” even if it is not a “functional” problem.

However, plaintiff Burton claims that Blue Shield of California denied her insurance claim request without considering whether or not the surgery would provide her with a “normal” appearance nor did they factor in the opinion of a reconstructive surgeon.

Burton alleges she appealed the Blue Shield decision, but was again denied medical insurance coverage.

The bad faith insurance claim denial class action lawsuit was filed in 2014 and sought to represent all Class Members who are policyholders of Blue Shield of California who requested reconstructive surgery coverage under a private employer health plan and were denied at any time within the applicable statute of limitations.

Blue Shield of California Claim Denials

A class action lawsuit investigation has been launched regarding the claims of California residents who have been denied insurance coverage of plastic surgery that helps patients recover to normal appearance following major weight loss.

While typical reconstructive surgeries may be considered merely cosmetic, the State of California has issued laws that insurance companies must cover procedures that are needed for reconstructive or health purposes.

Common bad faith insurance claim denials may include:

Breast Lift
Boob Job – Reconstructive Breast Surgery
Tummy Tuck
Body Lift
Eyelid Lift
Circumferential Body Lift
Complete Lower Body Lift
Mini Tummy Tuck
Arm Lift
Leg Lift
Buttock Lift
Abdominoplasty
Panniculectomy

Bad Faith Insurance Lawsuits

California health insurance policyholders who have had an insurance claim denied even though it would restore them to a “normal” appearance after major weight loss have the right to appeal the decision. Under the Affordable Care Act, insurance companies must explain why a medical claim was denied and patients have up to six months to get the decision reversed.

However, patients who have exhausted all methods of getting the insurance coverage they need may want to consider taking legal action against the insurance company. A bad faith insurance attorney can help California residents navigate their legal options of either joining a class action lawsuit or filing a bad faith insurance lawsuit as an individual.

The Blue Shield of California Bad Faith Insurance Class Action Lawsuit is Burton v. California Physicians’ Service dba Blue Shield of California, Case No. 3:14-CV-1892 in the U.S. District Court for the Northern District of California.

Join a Free California Bad Faith Insurance Lawsuit Investigation

A bad faith lawsuit investigation has been launched into allegations that some California insurance companies are refusing to pay valid medical claims or offering to pay far less than the claim is worth. Some of the companies being investigated for potential violations include:

Aetna
Anthem Blue Cross
Blue Cross of California
Blue Shield of California
Cigna
Health Net
Kaiser
Secured Horizons
United Healthcare
WellPoint
Others

If you or a loved one were denied coverage for autism treatment, mental health treatment, plastic surgery skin removal after weight loss, proton therapy for cancer, or some other medically necessary treatment, you may have a legal claim.

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