Originally Denied by OHIP for Pannilectomy...... after Appeal OHIP reversed decision
I had a consult with Dr. Sarah Wong in Scarborough in Sept 2011.
reside in Thunder Bay and we only have (1) plastic surgeon and I felt more confident in seeking out the services of someone who had done plenty of pannilectomy (the surgeon here does more breast lifts etc).
I had a great consult with Dr. Wong and in her opinion I was a good candidate and fit the criteria for a panni removal. I waited and I waited...FINALLY in February OHIP send their decision I was DENIED and the ONLY reason provided (borderline).
I contacted Dr. Wong's assistant, who informed me of my options and told me that I had the right to appeal Ohips decision...then the journey began..try finding out excatly where to appeal to was my first step..my letter to Kingston was returned undeliverable...and then subsequently I finally found the address of the location in Toronto. I was told at that time I only had (x) amount of days to file a formal appeal..which I did...I believe it was May 2012.
Then I was sent the necessary paperwork by the Health Services and Appeal Board (HSAB) at that time I had (x) amount of days to submit my documentation and my submission outlining my case. I also had to decide whether I would have a lawyer represent me and how I would present my case.
I can't afford a lawyer so I carefully outlined/stated my case that I felt I met all 3 of the criteria outlined by the Health Services Act. I also stated that I would travel to Toronto and would like my case heard in person.
After submitting my paperwork by courier with copies to OHIP and the HSAB...I waited, then a letter arrived stating my hearing would be held by teleconference on October 9.
On September 21 I received a phone call from the HSAB (Adjudicator) stating that OHIP had requested a 2 week extension and would I agree to it.
I did...with some hesitation as I thought that they were requesting more time to build their case against me.
WELL...yesterday...I received an envelope by courier and.......OHIP after reviewing the submitted documentation has decided to reverse their original denial!!!!!
It's been a year of fighting for this and the reason I am posting if anyone in the future is denied.....if and would like some guidance or suggestions on how to be a strong appellant and represent your case...just give me a hollar.
I can't promise that your appeal will be overturned, but I can assist in helping you interpret the OHIP standards of coverage and in laying out your documentation to support your case.
reside in Thunder Bay and we only have (1) plastic surgeon and I felt more confident in seeking out the services of someone who had done plenty of pannilectomy (the surgeon here does more breast lifts etc).
I had a great consult with Dr. Wong and in her opinion I was a good candidate and fit the criteria for a panni removal. I waited and I waited...FINALLY in February OHIP send their decision I was DENIED and the ONLY reason provided (borderline).
I contacted Dr. Wong's assistant, who informed me of my options and told me that I had the right to appeal Ohips decision...then the journey began..try finding out excatly where to appeal to was my first step..my letter to Kingston was returned undeliverable...and then subsequently I finally found the address of the location in Toronto. I was told at that time I only had (x) amount of days to file a formal appeal..which I did...I believe it was May 2012.
Then I was sent the necessary paperwork by the Health Services and Appeal Board (HSAB) at that time I had (x) amount of days to submit my documentation and my submission outlining my case. I also had to decide whether I would have a lawyer represent me and how I would present my case.
I can't afford a lawyer so I carefully outlined/stated my case that I felt I met all 3 of the criteria outlined by the Health Services Act. I also stated that I would travel to Toronto and would like my case heard in person.
After submitting my paperwork by courier with copies to OHIP and the HSAB...I waited, then a letter arrived stating my hearing would be held by teleconference on October 9.
On September 21 I received a phone call from the HSAB (Adjudicator) stating that OHIP had requested a 2 week extension and would I agree to it.
I did...with some hesitation as I thought that they were requesting more time to build their case against me.
WELL...yesterday...I received an envelope by courier and.......OHIP after reviewing the submitted documentation has decided to reverse their original denial!!!!!
It's been a year of fighting for this and the reason I am posting if anyone in the future is denied.....if and would like some guidance or suggestions on how to be a strong appellant and represent your case...just give me a hollar.
I can't promise that your appeal will be overturned, but I can assist in helping you interpret the OHIP standards of coverage and in laying out your documentation to support your case.
prior to surgery 323lbs....4 years post-op maintaining between 108- 114 lb loss.
life is AMAZING when you continue on the right path~!. Use your surgeons gift to the fullest~!
Mary
surgery done in Duluth, MN
Monica. (insert laughter) .I never said that "saggy boobs" are well taken care of in the North..I actually wouldn't go to him for that either
...after hearing first hand from some friends about his surgery and reading RATE MD's I wouldn't go to him to stich up finger..but then I guess you always hear the worst.
People in Southern Ontario should be appreciative of the access they have to well versed qualified surgeons~!!
...after hearing first hand from some friends about his surgery and reading RATE MD's I wouldn't go to him to stich up finger..but then I guess you always hear the worst.
People in Southern Ontario should be appreciative of the access they have to well versed qualified surgeons~!!
prior to surgery 323lbs....4 years post-op maintaining between 108- 114 lb loss.
life is AMAZING when you continue on the right path~!. Use your surgeons gift to the fullest~!
Mary
surgery done in Duluth, MN
CONGRATULATIONS MARY!! I'm still waiting on my OHIP apporval for a panniculectomy. Woot! Good luck with your surgery!
Karen
Ontario Recipes Forum - http://www.obesityhelp.com/group/ontario_recipes/ 
That is so great!! I'm still pre op but just recently started thinking of it and how I was going to pay for one if need be...but it's nice to know there is hope to getting it covered!
Congrats!
Congrats!
referral: fall 2010, orientation: march 2011, nut/psyc: fall 2011, nurse: jan 2012, tests: march 2012, pre-surg class: Sept 2012, surgeon, Sept. 2012. Surgery: Nov 8, 2012
Congratulations Mary -- always a good idea to appeal. Off topic, but when my son was very young and going to daycare, I looked into getting a subsidy and was told not to even bother applying because I made more than $12/hour. Well I applied anyway and was granted a full subsidy for 3 of the 4 years he was in daycare. I think it's a good idea to fight for something you believe is right.
Good luck going forward. Hope you don't have to wait too long for your surgery date.
Carol
Good luck going forward. Hope you don't have to wait too long for your surgery date.
Carol
Carol P
"Create your future from your future, not your past"
"Create your future from your future, not your past"
Congratulations ! Best wishes with the procedure, keep us posted.
The future belongs to those who believe in the beauty of their dreams. ~ Eleanor Roosevelt
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