Attorney Robert Gianelli filed a complaint in the Superior Court of Los
Angeles on September 14th, 2018, alleging that Blue Cross of California (doing business as Anthem
Blue Cross) wrongfully denied benefits and acted in bad faith towards
a client. The suit alleges that Blue Cross of California denied treatment
for his client’s stage 3 lipedema, claiming that the treatments
were cosmetic and thus excluded from coverage. The complaint alleges breach
of contract and breach of implied convenient of good faith and fair dealing,
and seeks general and special damages, attorney fees and costs, and punitive damages.
In the complaint, Attorney Gianelli and his client allege that Anthem Blue
Cross determined that there was no in-network provider with the expertise
to properly treat his client. Thus, her in-network doctor informed Anthem
that she should see an out-of-network doctor to have the procedure done.
Both doctors agreed on the diagnosis of stage 3 lipedema. However, Anthem
Blue Cross denied benefits for the proposed treatment, instead classifying
it as “cosmetic” and thus excluding it from coverage.
Lipedema is a disorder which affects up to 11 percent of women in which
legs enlarge due to deposits of fat beneath the skin. The disease is progressive
and debilitating. In stage 3 lipedema, fat tissue accumulations beneath
the skin protrude, causing bumps or projections in the knees or thighs,
which hinder mobility. In the early stages, lipedema surgery is often
done for cosmetic purposes, however in this case Attorney Gianelli and
his client argue that the procedure was clearly reconstructive, and thus
meets the standard behind California’s reconstructive surgery law
(CA Health & Safety Code section 1367.63).
The complaint further alleges that Anthem acted in bad faith by unreasonably
delaying responses to the initial claim, failing to properly investigate
her claim to learn the true nature of the treatment, misinterpreting facts
and contract provisions, ignoring medical information and evidence, and
disregarding obligations under the law.
Attorney Gianelli stated “Anthem’s disregard of Ms. Manuel’s
complaints regarding her need for treatment for her Stage 3 lipedema is
part of Anthem’s illegal practice of failing to properly acknowledge,
investigate and resolve its customer’s complaints. In an Accusation
filed by Anthem’s regulator, the Department of Managed Health Care,
on November 15, 2017, the Department alleged that Anthem has a long-standing
systemic problem of failing to address member complaints. The Department
is seeking systemic changes and a $5,000,000 fine against Anthem.”
The amount of damages that Attorney Gianelli is seeking on behalf of his
client will be determined at trial, the date for which has not yet been
If you believe your case has been wrongfully handled by your insurance
company and they may have acted in bad faith, review your options with
the Los Angeles insurance attorneys at Gianelli & Morris! Call us
at (213) 798-4860
to request a consultation.
GB: Attorney Robert Gianelli has recently filed a complaint on behalf of
a client who alleges Anthem Blue Cross has acted in bad faith, wrongfully
denying her benefits for treatment for stage 3 lipedema. Read our blog
to learn more about this case.
Facebook: Attorney Robert Gianelli has filed a complaint against Anthem
Blue Cross, alleging they acted in bad faith and wrongfully denied his
client benefits for a needed treatment for stage 3 lipedema. Read our
blog to learn about this complaint filed with the Superior Court of Los Angeles.
Twitter: Attorney Gianelli is taking on Anthem Blue Cross after they allegedly
acted in bad faith towards a client, for whom he has filed a complaint
on their behalf. Read our blog to learn more!