Denied approval for panniculectomy

Gingermags
on 7/3/18 11:12 am

Hi to all,

I learned today I was denied approval for a panniculectomy. My surgery was in January of 2008, and I was unaware that I could even apply for one at that time.

Is anyone familiar at all with the reasons I might have been denied? Has anyone had the same experience and would explain it to me?

I have to say I'm a lot deflated atm. I have constant trouble with yeast and have been using clotrimaderm on an almost daily basis for years. I also suffer low back pain from carrying it.

I would appreciate any and all advice you could offer.

many thanks,

Maggie

SweetRide1
on 7/3/18 12:00 pm
RNY on 01/16/18

Did your Doctor give OHIP all the information about back pain, yeast, sores, etc. when submitting the request? If they didn't you need to have them resubmit. You can also appeal the decision. You need to get all your ducks in a row, have your medical history documented, pictures, etc.

Keep at it.

Referral - May 31/17; Orientation - June 15/17; First Appt Nurse - June 26/17; Bloodwork and ECG - June 27/17; Sleep Study - July 5/17; Dietician Appt - July 10/17; Counsellor Appt - July 10/17; Abdominal Ultrasound - July 10/17: Endoscopy/Colonoscopy - July 25/17; Second Dietician Appt - September 14/17; Internist Appt - October 2/17; Meet the Surgeon - November 21/17; Pre Surgery Nutrition Class - January 12/18; Surgery - January 16/18

Gingermags
on 7/3/18 12:12 pm

Yes, I'm sorry, I'm sure I left things out and didn't make a lot of sense, since I had basically just hung up the call.

I was referred to a plastic surgeon by my family doctor. She had documented all of the things I described. The plastic surgeon confirmed all the symptoms, AND informed me I was a good candidate for surgery.

Is the appeal process difficult, do you know?

Maggie

SweetRide1
on 7/3/18 12:51 pm
RNY on 01/16/18

I don't know from personal experience. Hang in as others on this board have had their surgeries approved. Hopefully, someone with more experience will chime in.

Referral - May 31/17; Orientation - June 15/17; First Appt Nurse - June 26/17; Bloodwork and ECG - June 27/17; Sleep Study - July 5/17; Dietician Appt - July 10/17; Counsellor Appt - July 10/17; Abdominal Ultrasound - July 10/17: Endoscopy/Colonoscopy - July 25/17; Second Dietician Appt - September 14/17; Internist Appt - October 2/17; Meet the Surgeon - November 21/17; Pre Surgery Nutrition Class - January 12/18; Surgery - January 16/18

Hope_is_all_I_need
on 7/3/18 12:02 pm, edited 7/3/18 5:02 am
Diminishing Dawn
on 7/3/18 8:48 pm - Windsor, Canada

DId you have a doctor experienced with ohip? Key is usually the right doctor to advocate for you.

12+years post op RNY. first year blog here or My LongTimer blog. Tummy Tuck Dr. Matic 2014 -Ohip funded panni Windsor WLS support group.message me anytime

Gingermags
on 7/4/18 6:37 am

Wow, now that is a very good question. The plastic surgeon I consulted was Dr. Ronnie Borsuk, someone I heard via word-of-mouth that deals with post surgery pannis.

I would suspect now that I've applied and been denied it doesn't matter which Dr. I see?

Maggie

Diminishing Dawn
on 7/4/18 8:41 am - Windsor, Canada

Is this a Doctor who has worked with weight loss surgery patients and has gotten coverage for pannies only?I have not heard of this doctor.

Here's the secret about ohip coverage: Many doctors won't even bother to put in an ohip Attempt at coverage or they'll do a poor attempt at one. Some doctors want you to get denied so that you will pay full price. Many do not want to do the paperwork required for coverage.

My doctor that I chose was excellent at getting coverage. That's why I chose him. I saw patients that got denied and told them to go to my surgeon and they were approved. Surgeon choice makes all the difference in the world. A large part of being approved is what your surgeon tells them.

12+years post op RNY. first year blog here or My LongTimer blog. Tummy Tuck Dr. Matic 2014 -Ohip funded panni Windsor WLS support group.message me anytime

Gingermags
on 7/4/18 4:08 pm

This sounds like some very wise advice, thank you so much!

Is there anyone who might suggest that sort of plastic surgeon in the Ottawa area? I would be very grateful.

Maggie

Diminishing Dawn
on 7/4/18 8:41 pm - Windsor, Canada

Pm me.

12+years post op RNY. first year blog here or My LongTimer blog. Tummy Tuck Dr. Matic 2014 -Ohip funded panni Windsor WLS support group.message me anytime

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