California Judge Orders Kaiser to Broaden Reconstructive Surgery Coverage

A California judge has ruled that Kaiser Permanente cannot systematically classify removal of excess skin following bariatric weight loss surgery as a cosmetic procedure after a trial in a class action case.

The trial began in March.

The judge did find that doctors could decide on a case-by-case basis whether patients qualified for a referral to a plastic surgeon.

The Courtroom View Network reported that in his tentative ruling issued July 15, Alameda County Superior Court Judge Wynne S. Carvill stated Kaiser misinformed patients and doctors by claiming removal of disfiguring excess skin following gastric bypass surgery is not a covered procedure.

California law requires insurance companies to pay for reconstructive surgery to repair disfigurement caused by trauma or disease.

Carvill rejected Kaiser’s argument that excess skin is not a disease, and instead ruled that its policy of only providing referrals to plastic surgeons for patients whose excess skin presented a functional problem stands in contrast with the California Health & Safety Code’s requirement that reconstructive

The case is Wendy Gallimore, et al. v. Kaiser Foundation Health Plan Inc. It was heard in the Superior Court of the State of California for the County of Alameda.