Attorney Gianelli Files Complaint Against Anthem Blue Cross of California
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 established.
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 213-489-1600 to request a consultation.