OHIP Appeal Rant:

Apr 03, 2010

I am now in the appeal process with OHIP.  I find the entire process frustrating, discouraging and downright depressing.  OHIP is falsifying their wait times and seem to be against helping overweight Ontarians vs. trying to advocate for them.  I was approved for a RNY and when I asked if I could revise the currently approved RNY to a VSG they denied my request and withdrew my original RNY just for asking the question.  I have been in the appeal process for six months now and OHIP is trying to say that because my prior approval has now expired that I cannot appeal.   

So if I understand what they are saying, it goes something like this:

Me:  May I revise my pre approval for RNY to a VSG

OHIP: No you may not, and because you asked we are cancelling your prior approval for RNY

Me: You should never have deemed my prior approval as withdrawn just because I asked about another surgery

OHIP: Thank you very much, but now that your prior approved surgery is both withdrawn and expired you don't have a case

and if you think this is ludicrous....

OHIP tells me that the only way I can now get VSG or RNY is to be seen by an “Ontario Centre of Excellence”.  My family doctor and I have been trying to get in touch with the Hamilton Bariatric Centre for over six months now and they won't even call us back (nor e-mail or fax).  Yet OHIP tells me that from referral to surgery date is an "average 3-5 month wait".  Not only are they making this virtually impossible they are now misrepresenting wait times and averages.  It is obvious that wait times start from when they call you back…. not when you contact them.  What the heck is OHIP doing these days and why aren't they trying to help Ontarians?  It would seem to me that OHIP is all about keeping the funding they can within Canada and don't care how many people die on waitlists while they create their “Centers of Excellence”, educate Ontario doctors and post research papers on what they want the Ontario “gold standard” to be.  Did you know that Windsor is considered to be a “Centre of Excellence” although they have yet to actually perform WLS to date (information included in OHIP’s response to my appeal)?

I think people need to stand up and fight about this issue since it is disturbing what OHIP is doing

 

Is anyone going through something like this?  Do people even know that they can appeal OHIP?

Shay

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