Is is possible ... OHIP pay for DS in Montreal?

 I have decided that I want to have DS, instead of RNY.  There are so few doctors that perform the surgery, and I've only heard of 1 in Ontario.  

I would like to have my surgery with Dr. Gagner in Montreal.  

My doctor is going to consult with Dr. Gagner, to see what options we have.  I'm going to follow up with SunLife, to see what if anything they'll cover.  Tonight, I was on the Ontario Ministry of Health site, and found this...It refers to out of country surgeries ... Shouldn't out of province be basically the same?

OHIP Out of Country Services

Bariatric Services

The Ontario government is increasing the province’s capacity for providing bariatric services including surgery. It is expected that the number of bariatric surgeries performed in Ontario will increase to over 2,000 annually by fiscal year 2011/12.

The ministry requires that all patients requiring bariatric services, including surgery, must be referred by their physician to one of Ontario’s Regional Assessment and Treatment Centres (RATC) for evaluation.

To learn more about Ontario’s bariatric registry please visit the link provided below:
http://www.bariatricregistry.ca/

U.S. Preferred Providers: Bariatric Services

If a specialist from an Ontario RATC determines that a patient is a suitable candidate for bariatric surgery that cannot be performed in Ontario, the specialist has the option of submitting an application for out of country (OOC) prior approval.

Please Note: Applications for OOC bariatric surgery will only be processed by the ministry if the prior approval application has been submitted by a physician working at an Ontario RATC.

To obtain a list of the OHIP funded providers of bariatric services in the U.S. please visit the link provided below:
U.S. Preferred Providers

Nope it doesn"t work that way.  Dr. Hong in Hamilton will do the DS but you have to qualify for it.  Dr. Hong has sent two posters to Dr. Gagner - one was a revision and the other already had the VSG but was still too large for Dr. Hong's equipment/expertise  Ontario is not sending anyone out of province or out of country unless extremely unusual cir****tances.  

If you want Dr. Gagner and dont want to wait then pay the 18500 and get it done.  I dont think your plan will cover it as OHIP does cover it in certain cir****tances.

What is your BMI and why do you need a DS versus a RNY.  Its not just a matter of choice for us in ontario.  You have to prove why you need that surgery.  I had to do that just to have the VSG as the preferred surgery in Ontario is RNY.

If you are not in the Hamilton cachement area, have  your barictric center refer you to Dr Hong. However, I warn you be prepared, do tons of research and be prepared to argue for a DS along with medical support.

Not trying to scare you off, just telling you like it is.

I'm in Ottawa.  
BMI is 53.5.  
I have arthritis, sciatica and other pain issues so, I take NSAIDS pretty much daily.  


I've also been told, that because Dr. Hong is the only one in Ontario that does DS, the wait well exceeds the 2 - 3 year wait for RNY.  

WHo told you that? I am not aware of that long a wait.  Most are getting their sugery within a year or so at Hamilton. If you do all your appointments as set up you will get surgery fairly quickly.  Not heard 2-3 year wait in many years.

NSAID use is not going to be a valid reason for you to get DS covered in Ontario. There have been appeals on this issue.  Probably the best reason for DS will be a high BMI.

There's no 2-3 year wait for RNY. Most people get it done in 9 months to 18 months. The process isn't much different for any specific surgery - it's just going to be a case of making a plea for the ds rather than another surgery.

Dawn

That is absolutely not true. I was referred to the registry in November 2010. I went through asessment during the summer of 2011 at TWH and met with a surgeon who determined that RNY was not a good option for me due to my need to take NSAIDs for injuries and agreed to refer me to Dr. Hong at St. Joe's Hamilton to discuss DS. I met with him in November and he agreed that RNY was out and that VSG was probably insufficient due to my unusually young age for pre-diabetes and extremely strong family history of diabetes. He did not have to obtain OHIP approval for surgery and I will be having my DS with him in March. I have a BMI of 42-43. Pushing for the DS caused an added delay of about 6 months in my case, well worth it in my opinion.

If you believe the DS is right for you, you must meet with Dr. Hong. If he agrees, but thinks your case is too complicated for him, he will not hesitate to refer you to Dr. Gagner in Montreal. But first you need to see Dr. Hong.

I would be happy to share any information or studies I used to help me get my referral to Dr. Hong and to then convince Dr. Hong of the need for DS in my case. Please send me a private message!

You have to still go through an Ontario Assessment Centre to even be considered for it.  I am sure that once you are done all those appointments, Ottawa would make you go see Dr. Hong before sending you out of province.

 i've looked into having vsg in montreal, unfortunately MOH is no longer paying for bariatric surgery outside of province.  i've been told that MOH will not pay for any surgery done in Quebec 

Actually, if the RATC thinks the wait is too long and you need surgery within 6 months there is a possibility that they will send you out of country or out of province. The doctor at the assessment centre can apply for you to go to a "preferred provided bariatric centre of excellence". There are surgeons in the states, preferred providers who do the DS. OHIP has an agreement with Dr. Christou in Montreal but that is for the VSG or RNY only.
They will only send you to see Dr. Gagner if you are a complicated conversion (a revision implies you are having the same surgery just modified). My fight for my DS and to see Dr. Gagner took over 2 years and I was the first approved to have surgery with him in Montreal but since then it has been easier for others to get the DS. Dr. Hong had actually recommended to MOH that I see him. Dr. Hong has experience doing the DS since before he came to Ontario. He does virgin DSes and will refer the complicatied cases to Dr. Gagner (the cost for MOH can be x5 that of surgery in Ontario as it is often done in 2 parts).
Anyway, keep us updated...

I'm kind of hijacking here, but the people with knowledge of DS seem to be tracking this thread...so..

I have a lot of arthritis in several areas, and have been trying for the past two months or so to get used to tylenol/tylenol 1 for the pain, but when I get fibro flare ups, it just doesn't cut it. I miss NSAIDS already. I also am preiabetic, with a strong family history of it, and was diagnosed with colitis when I was 20ish (20ish years ago). I don't get a lot of flare ups, but occasionally, they return, and I have had ibs ever since. My father wears a permanent colostomy bag as do several other relatives. I was the first diagnosed, but the healthiest thus far. Wouldn't DS be the best choice because of the family history, and won't a RNY put me at risk for future flare ups? I'm going to ask the Dr. at the Windsor Clinic at my appointment in two weeks, but I was just looking for some information/advice now, and this looked like the best place to do it.