Dynamic Accident Lawyers: Kaiser May Have to Cover Weight Loss Skin Removal Surgery

A weight-loss surgery patient was given a tentative order from a California judge requiring Kaiser Permanente to stop automatically denying coverage for excess skin removal following bariatric surgery.

Judge Wayne S. Carvill determined that Kaiser insurance’s practice of categorizing skin removal surgery as cosmetic and denying coverage on that basis was inconsistent with a California statutory requirement that “excess skin removal procedures be made available on a covered basis (that is, as reconstructive surgery) when such procedures would improve function or address an abnormal structure so as to create a more normal appearance to the extent possible.”

Judge Carvill said he would likely order Kaiser insurance to revise its bariatric surgery informational materials to ensure they comply with the state law.

Plaintiff Wendy Gallimore filed this bad faith insurance class action lawsuit in 2012 against Kaiser. She said that in 2006 she underwent bariatric surgery and subsequently lost over 100 pounds. The profound loss of body mass left her with large amounts of excess skin, she claimed.

Kaiser denied Gallimore’s request to authorize skin removal surgery. The company argued that such surgery was merely cosmetic and therefore not covered by Kaiser insurance. Gallimore said Kaiser told her the company never covers such surgery.

Gallimore argued in her Kaiser class action lawsuit that her skin removal surgery should have been covered under her Kaiser insurance because that surgery would address “abnormal structures of the body caused by . . . disease.”

In addition, she said that Kaiser makes a practice of systematically denying coverage for post-bariatric skin removal surgery, and that that practice was a violation of California bad faith insurance law.

Kaiser insurance has stood behind its determination that the surgery Gallimore wanted coverage for was merely cosmetic. The company says Gallimore’s body does not have any “abnormal structures” that could be restored.

Kaiser claims it does not have a standing policy of denying a particular type of surgery. The company says it always lets its doctors use their discretion to decide on a case by case basis whether a particular surgery would be cosmetic or reconstructive.

Kaiser also argued that it adequately warns patients undergoing weight loss surgery of the possibility of excess skin. As part of a presentation that Kaiser requires such patients to attend, these patients are told that Kaiser does not cover the cost of “cosmetic” surgery to remove excess skin.

Gallimore filed her claim as a bad faith insurance class action lawsuit. She wants to represent all California residents covered under Kaiser insurance who had been denied coverage for “reconstructive surgery to correct or repair abnormal structures of the body to create a normal appearance to the extent possible.”

The California woman also sought to represent a sub-class of plaintiffs who had specifically been denied coverage for post-bariatric skin removal surgery.

Judge Carvill may also require that Kaiser should send notice of its change in criteria to all of its primary care physicians, directing them to discuss those criteria with all patients suffering from excess skin conditions. The judge stopped short of ordering Kaiser to notify all Class Members of the revised criteria, saying the class’s expectations should not be unduly raised.

The Kaiser Insurance Skin Removal Class Action Lawsuit is Wendy Gallimore v. Kaiser Foundation Health Plan, Inc. Case No. RG12616206, filed in the California Superior Court for Alameda County,

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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