Kaiser's Class Action Lawsuit for Plastic Surgery after Bariatric Surgery

Patient Expert

Class Action Lawsuit Over Insurance Coverage for Excess Skin Removal Following Bariatric Surgery Is On In California aiser Denies Coverage for Plastic Surgery after Bariatric Surgery

"Who is going to pay for that?" or "How are we going to pay for that?" are two questions that probably get asked with some frequency in any American household. Finances can become tight for anyone, especialyl when high-priced demands become present.

In the United States, health needs are among the most common of those high-priced demands. Insurance is often the calvary that rescues the average person from the dollar demands of health woes, but what should you do when the calvary won't come?

In California,  Kaiser Permanente is denying coverage for excess skin removal for nearly 10,000 patients who have had weight loss surgery. The question at hand is are they obliged to provide that coverage?** Kaiser Foundation Health Plan Inc.**

Kaiser is a prepaid health care service plan and offers facilities through which participants can obtain medical services. Members must make an appointment at an area Kaiser location and then follow the diagnosis and treatment plan prescribed by the primary physician. The primary care physician must make a referral if the client wishes to see a specialist.

In 1998, the California Legislature enacted a statute which stated that all health care service plans must cover reconstructive surgery to correct abnormalities, trauma, congenital defects, infection, tumors and disease in order to improve function or create normal appearance as best as possible.

Wendy Gallimore feels that she met the criteria for surgery as outlined in the statute but was still denied service.

The Plaintiff Files Class Action SuitWendy Gallimore filed a class complaint against Kaiser in Superior Court, 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.** Her request for corrective surgery following extreme weight loss was denied despite her contention that she met the criteria for reparation to abnormal body structures caused by a disease.** In 2013, the American Medical Association recognized obesity as a disease.

According to the class action complaint, the statute was enacted because health plans denied reconstructive surgery based on the contention that such surgery was medically necessary to improve or restore bodily function but not to restore normal appearance.

Is Excess Skin Removal Cosmetic Surgery?

Kaiser attorney Mark Palley argues that the statute is intended to cover issues such as children's congenital defects but not issues of excess skin removal. Palley maintains that the removal of excess skin is cosmetic surgery and not covered under the statute. He states that he believes the intent of the plaintiffs is to pass along the cost for surgical removal of excess skin to others and thereby cause a raise in premiums.

The trial is taking place in Alameda County Superior Court in California and is expected to continue for two weeks.

Please weigh-in: Is removal of excess skin after massive weight loss a reconstructive procedure to restore normalcy that should be covered by insurance? Share your voice in the comments section below.

Living larger than ever,** My Bariatric Lifisit me on  ** MyBariatricLife.org**,** ** Flickr**,  Vimeo,  Twitter,  YouTube,** ** StumbleUpon**,  Google+ iew my** ** Borne  Appétit  recipe collection on Pinterest****  ** ** References**

Insurance Journal

Lexis Nexis

Legal Newsline