Anyone done an Appeal after Denied by OHIP?

I had my RNY surgery and last fall visited a plastic surgeon to have a consult for a panni removal, after waiting to hear from OHIP for 5 months my surgeons office called me in Feb 2012 and told me that my request was denied and the reason given was (borderline).

I have since sent in my 1st letter to APPEAL..and now I received back this huge package from the Appeals Board (which is seperate from OHIP) and the ball is in my court

I can choose hearing (in person, (in writing) or (on telephone), in the informaito it states that the Hearing Board may be comprised of up to (3) individuals, and it could be a public hearing unless I request that it not .

My question is has ANYONE gone down this road and seen in trhough to the end.

I am considering on requesting that my hearing be held in perosn, although I am not sure how comfortable I iwll be discussing the reasons that I have for believing that this surgery would benefit my health..also it states that the appelllant shoud familiarize themselves with the Ontario Statue Law regarding what the government should provide as far as health care.

Any insight or suggesitons would be appreciated.

Once this is all over I will be willing to share my journey/obstacles with anyone in the future.


Thank you

 Still pr-op but I wanted to say good luck! 

Ruth H. and Jennifer did, they were denied DS about three years ago. both lost on appeal.

Ruth went self pay, Jennifer, however, gathered medical evidence, got Ontario endo expert on her side to prove that her RnY was causing nesidioblastosis with all the damage already caused...  reapplied and got approved.

New application - it's important. they did not reversed the old decision, they made a new one on the new application.

Good luck.

thanks to you both.... I figured since I laid out so much of my personal life and embrassing things in the appeal letter that since that has already been passed on to the Appeal Board...I might as well brush up on the Health Act and see what if anything I can do.  I did consider hiring a lawyer....but figured that MAYBE my own discomfort in front of someone discussing personal aspects may lean in my favour...all I can do is try~!

I was going to suggest that you do it in person. Have pictures, too, if you feel comfortable sharing them with these people. THey need to hear it from your mouth, from a real person (not a lawyer) about how not having this surgery will affect you.


Good luck with this, please let us know how things progress for you. If i can help you at all, with writing things up, i kind of have a way with words, and will help you write it up, if you give me the ideas of what you want to say. Send me a private message with your email address, or ask for mine, if you want my help that way.

Mon

Linda T from London was denied PS and her surgeon appealed it I believe.  You could always contact her to see how it went down.  She is the only person I have seen get a PS denial overturned.  I"m not sure if he just sent in another request with more info or if he did a formal appeal.

As Nata said, the only others I have seen appeal are Ruth and Jen and both got nowhere with it being overturned.

Here is LInda's profile if you want to PM her.

www.obesityhelp.com/member/twins4meplus1/

My request for Panniculectomy in 2009 was denied but I did not fight that decision. If I were to be denied today you can bet that I would fight it. I just didn't know how to do or what was involved back then.
My request for Breast Reduction as also denied (twice in fact) but it was my Plastic Surgeon who fought back and had that decision overturned. He had never had a request for Breast Reduction denied ever before mine.

Linda

I wold go in person, armed with some"expert opinions" (letters from doctors,etc.). It would also be realllly tempting to "let it all hangout" and have pictures. Probably the most important thing to have is expert opinion concerning current and future health care burden of the loose skin versus the cost of the one time surgery.

Good luck!

Lori

Thanks very much Lori I appreciate your advice and will add that to the list when compiling my documentation.