Gallimore v. Kaiser Foundation Health Plan, Inc. Alameda County Superior Court Case No. RG12-616206

Gianelli & Morris Wins Case on Behalf of Weight Loss Patients

Gianelli & Morris won a class action lawsuit brought against Kaiser Foundation Health Plan (“Kaiser”) on behalf of plaintiff Wendy Gallimore and thousands of other Kaiser bariatric patients who were denied reconstructive surgery to remove excess skin after extensive weight loss. Kaiser claimed that reconstructive surgery was unnecessary unless patients experienced some sort of functional impairment, refusing to provide surgery to eliminate excess skin from arms, thighs, hips, and other areas. According to Kaiser, operations of this nature were “cosmetic.”

Following a month-long trial in Alameda County, the courts entered a judgment against Kaiser, stating that they acted in violation of California’s Health & Safety Code 1367.63. Under this law, health care plans must cover reconstructive surgery in the event that it will improve a patient’s function or create a normal appearance to the extent possible. As a result of the decision, Kaiser must now alter its procedures and provide reconstructive surgery to create a normal appearance. It is estimated that this judgment will force Kaiser to provide more than $150 million worth of reconstructive surgery benefits to its members.

If you or a loved one are a Kaiser weight-loss patient and wish to find out more about how this judgment may affect your right to skin removal surgery, call our office today at (213) 489-1600 to speak to the legal team that won this case.

Fighting for CA Insurance Policyholders Since 1979

At Gianelli & Morris, our Los Angeles insurance attorneys have fought and won against various insurance providers throughout more than three decades of legal practice, recovering millions on our client’s behalf along the way. Having earned a prestigious AV Preeminent® Rating from Martindale-Hubbell® for our superior ethics and skills, our knowledgeable legal team can provide the top-rated advocacy you need to ensure your rights as an insurance policyholder are upheld in a court of law. If you believe you have been unfairly treated by an insurance company, we urge you contact our firm today and let us use our expertise to fight for the coverage you deserve.

For detailed information regarding the case Gallimore v. Kaiser Foundation Health Inc, read the Statement of Decision.