Dr Hagen disapproved VSG..does anyone know OHIP appeal method?

 He did say it is not an option forme. He did say however ifi can get OHIP To cover it. He will support me. He says because he has criteria he needs to be approved by them. He just can't do On for the sake of just because I want it..

Anyone been in this predicament?  How did you deal with it?

I still really want the sleeve. Even though he said RNY is safer and healthierin the long run?

I thought I wanted the VSG too. But the surgeon I met recommended the RNY based on my medical history. My struggle with the procedure is the idea of intestine being detoured. Curious why you want to fight for the VSG.

Did he say why the RNY is safer and healthier in the long run?  There isn't a lot of really long term studies out for the VSG as it has only been in existance for about 10 years, but many people have had most of their stomach's out for many years due to bad ulcers, stomach cancer etc., and I've really never heard anything bad about the VSG long term.

I was approved for a VSG because I had a lot of adhesions (scar tissue) from previous surgeries. 

Does Dr. Hagen do VSG's?  I don't remember seeing anyone with a VSG from him??  Maybe you could switch surgeons (making sure to choose one that does VSG's)?

Yes he does VSG.  He did Oknee and a few others that posted about him only a few weeks ago.  He is very by the book and follows OHIP's Schedule of Benefits to the letter so if you don't meet OHIP"s criteria according to that, he won't do it.  Other surgeons apparently will but he won't.  He's as strict about following it as Guelph is about their no red meat for 6 months and no protein shakes ever.

Oh don't forget Guelphs NO weight gain pre op,too! :/

Yep, you're right, I forgot!  I hear he's a great surgeon, too bad he's so good at following rules too, lol.

Here are OHIP's rule for VSG in case you are not aware.

Note:
1. S114 Sleeve gastrectomy is only eligible for payment when:
a. a Roux-en-Y gastric bypass is not possible due to small bowel disease/adhesions or
previous surgery; or
b. performed as a planned staged surgery in patients with a BMI > 60 to enable the
patient to lose weight.


If it were me, I'd ask for a 2nd opinon with a surgeon that seems to give the patient the option.  I am not sure which surgeon that would be but others may chime in with one that gives you a choice.  I think appealing it will get you nowhere as it is very black and white right in their schedule.

Dr. Hagen, and HRRH in general, has an anti-VSG reputation. Surgeons can justify doing a VSG very easily, he just chooses not to. They still believe in a one size fits all 'RNY gold standard' bariatric philosophy.

Do you have any medical reasons, at all, for preferring the VSG? Do you need to take NSAIDs? Do you have a history of anemia or osteopenia? Do you have previous abdominal surgeries?

What you need to do is request a referral to a different surgeon for a second opinion. I would recommend any surgeon at St. Jo's Hamilton, as they are very open-minded and actually care about patient's preferences in determining the best surgery for a patient. Don't be bullied into a RNY if you don't believe it is the right surgery for you, just find a more open-minded surgeon.

pretty damning post considering you never set foot within HRRH. 

I had no fight to get my VSG and I see a number of them preformed at HRRH weekly without any argument.  There is criteria, unfortunately "NSAID dependence" is not one of them. 

As mentioned before, the last time criteria was disregarded (Spring and summer 2010) OHIP clamped right down on the procedure and forced surgeons to strictly apply the criteria. 

The last time they clamped down patients we told on the table that they didn't meet criteria for the VSG they were scheduled for and the choice was RNY or to rebook when they could provide guarantee of payment. OH and not just HRRH but I heard similar versions to the same story out of Sr. Mikes, TWH and St. Joes. .

I have noticed VSG's being done fast and furious in the past couple of months. . .perhaps OHIP has pulled on the reins again. . .YOU REALLY DON'T KNOW everything is so "hush-hush". 

Criteria exist, rules exist. . .a leveling of the playing field has to occur

You know Leona, if you're going to respond to my posts and insult me then it would be more sportsmanlike if you unblocked me.

I don't see how your post is at all helpful to the OP. You got the VSG because you had a medical reason that did not allow you to have RNY. This is completely different than the approach recently being taken by many surgeons where patient choice and a broad range of medical issues, including NSAID use, are considered legitimate concerns when determining an appropriate surgery. I will always encourage people to seek out healthcare providers who will dialogue with them, rather than dictate, the best course of action for their health. Why any surgeon thinks it is wise to deny a perfectly valid bariatric surgery to someone in need of WLS, simply because it is not that surgeon's favourite WLS, is beyond my meager understanding. At any rate, my point of posting is to help the OP, not argue with you, so I'm done here.