Kaiser Denied Skin Removal Surgery After Weight Loss, Class Action Says

Kaiser Permanente was hit with a class action lawsuit alleging that it refused to provide reconstructive surgery for a California woman who wanted excess skin removed following massive weight loss.

After undergoing bariatric surgery for the treatment of morbid obesity, lead plaintiff Wendy Gallimore requested that her insurer, Kaiser, authorize coverage for reconstructive surgery to the remove large amounts of excess skin.

Kaiser denied her request despite her contention that she met the criteria for repairing abnormal body structures caused by a disease. In 2013, the American Medical Association recognized obesity as a disease.

Gallimore filed her class action lawsuit against Kaiser in California Superior Court in 2012, claiming that Kaiser has a history of violating the statute by refusing to cover reconstructive surgeries that would correct the problem of sagging skin after bariatric surgery.

According the Kaiser insurance class action lawsuit, “Kaiser systematically ignores both the functional impairment standard and the ‘normal appearance’ prongs of section 1367.63(c) and, in doing so, systematically violates the statute.”

In fact, the class action lawsuit alleges that Kaiser refused to cover excess skin removal for nearly 10,000 patients who have had bariatric surgery.

However, the Kaiser skin removal lawsuit argues that the statute is intended to cover issues such as children’s congenital defects but not issues of excess skin removal. Kaiser maintains that the removal of excess skin is cosmetic surgery and not covered under the statute.

Prior to enactment of the California Statute in 1998, insurance companies claimed such surgeries were cosmetic, and would only provide coverage if surgery restored bodily function, not restore a normal appearance.

The relevant section of California rules was clarified and now states: “Reconstructive surgery means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (A) To improve function; (B) To create a normal appearance, to the extent possible.”

Bad Faith Insurance Lawsuits

If you were denied coverage for a reconstructive surgery following massive weight loss by your insurance company in California, such as Kaiser, you may have legal recourse. An experienced insurance lawyer can evaluate your case and explain your legal options for free

The Kaiser Bad Faith Insurance Class Action Lawsuit is Wendy Gallimore, et al. v. Kaiser Foundation Health Plan Inc., Case No. RG12616206, California Superior Court for the County of Alameda.

Join a Free California Kaiser Bad Faith Insurance Lawsuit Investigation

A bad faith lawsuit investigation has been launched into allegations that Kaiser Permanente in California is refusing to pay valid medical claims for skin removal following significant weight loss or weight loss surgery.

If you or a loved one were denied coverage for plastic surgery skin removal after weight loss, you may have a legal claim.

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