update and plastics

Hi all, I know I don't update nearly enough on here so I thought it was time.  I am currently about 10 lbs from goal but thinking I may want to lower my goal weight :)  So from the start it is a loss of about 170lbs or another person.  I will be seeing a new plastic surgeon today to discuss a pannectomy.  I am excited as this is a new plastic surgeon to Thunder Bay and it means to having to travel for plastics.  His name is Dr Azad and i will definately post a review after my consult. 

 

Robin

First of all, congratulations on your weight loss! That's awesome!

Just a quick question for you or anyone else that may be reading this and know...

Are any of the post-weight loss skin surgeries covered (in part or whole), or is it all out of pocket?

Pannectomy and breast reduction covered but not tummy tuck and other proceedures

as I posted above they are not automatically covered and I want to make sure that people are aware of that, just because you go to a plastic surgeon and he/she says you are a good candidate doesn't mean that OHIP will grant you coverage.

skin surgeries are only covered by OHIP, if OHIP deems them medically necessary

 

...they have 3 guidelines that have to be fulfilled and they are becoming more and more strict on those guidelines

Do you  know what the guidelines are? Or how to find them?

On July 2, 2013 at 1:06 PM Pacific Time, Mandalious wrote:

Do you  know what the guidelines are? Or how to find them?

here it is...remember what and how you interpret it may be the bare minimum, whereas I am sure that OHIP has much further detailed guidelines. 

 Please also remember that OHIP has to find the submission from the Plastic Surgeon medically necessary it has nothing to do with plastic/cosmetic surgery.

People have a much better chance at having an pannilectomy approved if they have diagnosed/recorded issues with back pain, fungal rashes etc....documentation is a necessity~!

(therefore as embarassing as it may be that you have developed a fungal rash in your fold...get it documented by your/a physician don't do over the counter treatment yourself.

...it helps with your case should you need to appeal a DENIED decision from OHIP.

 

[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.]

Interesting , I already deal with cellutis and have had MRSA infections with them. Horrible 

as long as it's a re-occuring problem & if it's in the area that may benefit from surgery, then make sure to have all of your documentation handy.

I know for sure that you have to have issues with rashes, infections, hygiene issues, etc.  as well, the pannus has to hang down a good deal - if it is covering the mons and resting on your upper thighs, you're probably good to go on that one.  But you never know with OHIP.  I think it has a lot to do with how your surgeon presents your case as well.