OAKLAND, Calif. (Legal Newsline) – Next week, a two-week trial will begin in a class action lawsuit filed against health care service provider Kaiser Foundation Health Plan Inc. over its alleged refusal to cover excess skin removal surgeries.
The trial will take place in California’s Alameda County Superior Court starting Monday. It will be webcast live and recorded on Courtroom View Network.
Alameda County Superior Court in Oakland, Calif.
In her class action, plaintiff Wendy Gallimore, on behalf of herself and others similarly situated, alleges that Kaiser violated California law by refusing to cover the skin removal surgery.
The surgery is typically done in patients who lose a significant amount of weight after lap band, or stomach stapling, surgery.
According to her complaint, filed in the superior court in February 2012, Gallimore underwent bariatric surgery for treatment of morbid obesity. Following the surgery, she experienced massive weight loss and was left with large amounts of excess skin.
At that time, she requested that Kaiser authorize reconstructive surgery to remove the excess skin. Kaiser denied the request.
Gallimore argues that her condition satisfied the requirements of state statute — Health and Safety Code section 1367.63, enacted by the California Legislature in 1998.
The statute, according to the class action complaint, was enacted because health plans were denying requests for reconstructive surgery on the basis that it was only medically necessary to restore or improve a bodily function, not restore a normal appearance — even in cases where a physical abnormality was caused by trauma, disease or congenital defects.
Basically, the plans claimed such surgeries were “cosmetic.”
To remedy the problem, section 1367.63 made clear that health plans must cover surgeries to correct abnormal structures of the body caused by disease when the surgery would improve function or create a normal appearance to the extent possible.
Gallimore argues that Kaiser has a “pattern and practice” of violating the statute by not covering such reconstructive surgeries, including her own.
“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,” her lawyers wrote.
Los Angeles law firm Gianelli & Morris is representing the plaintiffs.
From Legal Newsline: Reach Jessica Karmasek by email at [email protected].
