Lawyer Contends Insurers Are Illegally Denying Skin Removal Surgery

OAKLAND (CBS SF) -- A recent ruling by an Alameda County judge could make it easier for formerly obese patients to get skin removal surgery.

The ruling found Kaiser Permanente violated Calfornia's Health and Safety Code by refusing all requests to remove excess skin following bariatric surgery. This month,  Kaiser started mailing out notices to about 9,000 patients informing them they may now be eligible.

Briane Barsi is hoping the ruling will help convince her insurer, Blue Shield,  to pay for her skin removal surgery.

Four year ago, Barsi lost 150 pounds through diet and exercise.  Since then she's been asking the insurer to cover the procedure,  which her doctor contends is medically necessary to avoid things like chafing and painful sores that can lead to infections.

But Blue Shield always says no, saying it's not a "covered benefit."

"It's very frustrating," Barsi told Consumerwatch. "This is not a 'mommy makeover.'"

Lawyer Robert Gianelli, who brought the suit against Kaiser, contends those denials are illegal.

"Under the law, the health plan has to pay for that," said Gianelli.

The law is California Health and Safety Code section 1367.63.

"The law says if through trauma, disease or some other event you have an abnormal body structure and surgery can improve function or return you to a normal appearance,  it's a covered benefit," Gianelli explained. "That's because obesity is considered a 'disease.'"

Gianelli is now leading a fight to force more insurers in California to pay for skin removal surgeries.  His next target is Briane's insurer Blue Shield.

Blue Shield, has refused to comment on Briane's case or the accusations it's breaking the law.