OAKLAND, Calif. (CN) - Whether Kaiser owes its patients coverage for reconstructive surgery after massive weight-loss procedures remains a question hung on what constitutes a "normal appearance," in the class action's second week at trial.
Lead plaintiff Wendy Gallimore, a teacher covered by the Kaiser Foundation Health Plan, claims that plan systematically refuses to pay for removal of excess skin after bariatric surgery, such as gastric bypass, in violation of a provision California's Reconstructive Surgery Law.
The law requires health care plans to cover reconstructive surgery performed "to correct or repair abnormal structures of the body" necessary "to improve function" and "to create a normal appearance."
Gallimore's attorney Robert Gianelli called John Katzen, a plastic surgeon practicing in Beverly Hills, to the witness stand Wednesday.
Katzen, who said he performed 1,200 to 1,500 post-bariatric procedures last year, said the normal appearance standard does not imply bodily perfection.
"We need to create a normal appearance, not a super Athena body, not a perfect 10," he said. "Just a five out of 10 is OK."
Medical journals have stratifications on a patient's abnormal versus normal appearance, Katzen said, but in his everyday practices evaluating patients, he said, "I know it when I see it."
Kaiser's attorney Mark Palley repeatedly objected that Katzen's testimony did not apply to Kaiser's practices, the ones at issue.
On cross-examination, Palley asked him to cite scholarly support that quantified his appearance evaluation standards, which Katzen was not able to provide.
Alameda County Superior Court Judge Wynne Carvill is presiding at the trial, which is expected to last until the end of the week.
Gianelli is with Gianelli & Morris in Los Angeles. Palley is with Marion's Inn in Oakland.
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