Panniculectomy denial

Mahalo F.
on 10/7/19 11:22 am

Panniculectomy denial

Oct 07, 2019

Hello everyone!

It has been sometime since I posted on this website. I had gastric bypass roux-Y in January 2017. I have lost 130 pounds and have maintained the weight loss for the last two years. I look and feel great! The gastric bypass bypass was life-changing for me.

This question is for Canadians covered by OHIP.

I have had a consult with a plastic surgeon. Hesubmitted in all the paperwork for the panniculectomy. Ultimately, I?m going to have a complete abdominal plasty. Pay the difference. The problem is OHIP has denied the authorization to cover cost. My panni hangs half over my mons pubis (mons Venus). I hate how it sits in my lap while on the toilet. I have had rashes/excoriations & odour. I have purchased just about every over the counter sprays and powders to keep the area clean without too much success. I wear compression panties to hold it in but that is ultimately causing irritable bowel from the intestinal compression. I have gone back to see the surgeon. The biggest problem for me is that the Panis doesn?t hang well below the pubis symphysis. We have appealed the decision. I submitted a well written letter to the appeal board. My question is has every anyone ever been denied a panniculectomy and then ultimately the appeal reversed the decision?

I am feeling frustrated!

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Roux En Y - Jan. 4, 2017

HW 283 SW 260 CW 167

Wt.Loss M:1-23 - M:2-14 M:3-13 - M:4-12 M:5-8

IN THE END WE ONLY REGRET CHANCES WE DIDN'T TAKE.

Liz J.
on 10/7/19 12:54 pm - Saint Louis, MO
DS on 11/29/16

I know nothing about the coverage in Canada. I just wanted to wish you luck in your appeal.

HW: 398.8 SW:356 GW: 175 CW:147

White Dove
on 10/9/19 12:21 pm

If you don't meet the requirement to be covered, bite the bullet and pay for the entire surgery yourself. You will not regret it. Think of it as being like buying an automobile. You put out a lot of money, but it will not last a lifetime like your tummytuck will.

Real life begins where your comfort zone ends

Kath L
on 10/22/19 10:44 am

I don't specifically know about this but am interested in the answers you get.

I think I had heard that for it to be covered, it had to be "medically necessary." Maybe the best letter to have written is from your doctor as to his/her medical opinion.

I do agree with the answers above in that you should still try to get it done, even if you have to pay the difference.

Kathy

Referral: Feb 14/17; Processed: Apr 28/17; Hamilton Orientation: July 24/17; Pre-Nutrition: Oct 27/17; Re-Do Hamilton Orientation: Apr 29/19; Pre-Nutrition: May 17/19; Nurse: May 29/19; Blood work: Aug 2/19; EKG: Aug 1/19; Allergist: Aug 15/19; Abdominal Ultrasound: Sep 4/19; Dietician: Sept 9/19; Internist Dr. Taboni: Oct 10/19; Social Work: Nov 06/19; Endoscopy Consult: Nov 08/19;

ScaleSkater
on 10/25/19 10:11 am

I'm in the US, but they paid for the hospitalization and about $1,200 of the fee. I had to put up the other $18,000. But mine included the arms too.

HW 510 / SW 424/ GW 175 (secondary after PS) / CW 182

RNY November 2016

PS: L/R arm skin removal; belt panniculectomy - April, 2019

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