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; Gastroscopy: Nov 21/19; Meet Dr. Gmora: Dec 4/19 Pre-Op and Surgery Class: Jan 09/20 Surgery: Jan 13/20 OMG they moved it up to Jan 06/20

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 177 (stretch goal to get 10 under) / CW 180

RNY November 2016

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

Girlie2
on 12/2/19 11:51 am

Hello Mahalo,

Just checking to see if you have made any progress with your appeal?

Leslie W.
on 12/10/19 6:27 pm - Cobourg, Canada

Haven't logged in for a long while. Many surgeons wont just do a panni due to poor results. Look at doing a TT. it is about $7500. I use Dr. Nandagopal at Usculpt for all my plastics. He is in Vaughan. Just a panni wont give you great results. Who ever you choose make sure they work with WLS patients as we heal differently

    
Referral: August 2010 Orientation TWH: May 25, 2011  NP: June 8/11, f/u sleep clinic June 7, abd u/s June 14, SW: June 28/11  Nutrition Class: July 5/11, Dietician Aug 09, Psychologist Aug 25 Surgeon Sept 16th Surgery Date: Oct 11/11 HW:287, Opti wt: 260 SW: 242
My Angel is Sheri TK   
ClassyIrishLass
on 12/11/19 9:42 am

Hello there. I am sorry you will not be covered. I had a panniculectomy in May of 2018 and my apron of fat was mid way down my thighs and they wouldn't pay for me to have it removed either. I had to pay to have this done all out of pocket, I am also in Ontario.

I was so lucky to have found a surgeon that would help me as I am a higher risk case, but I found one and it was life changing surgery. He removed 23 lbs of flesh and although that weight came back, it did not form another apron. My thighs and arms got bigger as did my upper tummy area, but no apron. It was $8500 plus tax, CDN.

The dr was M. Elahi in Toronto and he operates out of Scarborough General. He will take higher risk cases and is a wonderful, caring man, and his staff is very nice. I was kept 2 nights in hospital and it was a wonderful experience. I cannot even use the word pain, more discomfort and soreness. It was all far easier than I ever imagined it would be.

Good luck on your appeal.

Flair77
on 5/13/20 8:06 pm

Hello

I went through the process of OHIP application. The surgeon submitted my application and was asked for further info. He sent it and they denied. He resubmitted. Denied. He handed me the papers and said "good luck with the appeal." I immediately started the process and submitted my appeal to the Medical Eligibility Committee. I had three doctors submit letters advocating for the necessity of this surgery. I wrote a three page letter outlining the impact the loose skin was having on my health. In December 2019 I received their decision. Denied. The MEC has not overturned one OHIP denial. Ever.

Good luck.

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