OHIP and Parameters for consideration for approval of Pannilectomy etc

I have been asked for the following several times so I thought I would create a thread for it, that was if someone searches OHIP this should show up.

 Please note that this is posted by OHIP and these are the parameters of CONSIDERATION...and I am sure that OHIP has a much more lengthy guidelines.

It doesn't mean that because you or even your surgeon feel you meet these criteria that you will be automatically approved for surgery.

 

 

PDF] Appendix D - Ontario

www.health.gov.on.ca/english/providers/program/ohip/.../append.pdf Appendix D April 1, 2012 ..... Panniculectomy is only insured in the following cir****tances and when ... approval of the General Manager of OHIP is required.

SUB-SURFACE PATHOLOGY

16. Excision of excess fatty tissue and/or skin

a. Panniculectomy is only insured in the following cir****tances and when prior authorization of payment is obtained from the MOHLTC:

i. where there is significant associated symptomatology related to the pannus;

ii. where the pannus extends to a level below the pubis symphysis; and

iii. where the patient’s weight has been stable for a minimum of 6 months when panniculectomy is requested in relation to weight loss.

b. Excision of excess fatty tissue and/or skin other than for panniculectomy is not an insured service.

[Commentary:

Examples of significant clinical symptomatology include significant pain, chronic skin breakdown, and recurrent cellulitis and/or ulcers.]

 

Thank you for posting this...  Did you go through your family physician or through your bariatric center for referral ?

Amy

 

I do not have the services of the bariatric clinic as my surgery was performed over 4 years ago in Minnesota, so I went to my follow-up doctor and because of the limited access to plastic surgeons here in Thunder Bay (there was 1) that did everything from toes repair to mastectomy etc

..I choose to be referred to a wonderful female plastic surgeon in Scarborough that is an expert on breast reconstruction and bariatric surgeries

 

I am not sure how things are handled in Ottawa and Southern Ontario, as you have much more abundant choices in every type of physician..so maybe someone from your area who has had plastic surgery will respond also.