LEARN, SHOP & CHAT ABOUT PLASTIC SURGERY, BEAUTY AND ANTI-AGING
You're here: Home > Message Boards > Plastic Surgery > Tummy Tuck, Abdominoplasty

Plastic Surgery, Beauty, Skin Care Message Boards & Blogs

Our message boards are for all of us who want to talk, listen, share, and support fellow women and men interested in discussing plastic surgery, beauty treatments, pregnancy, gynecological concerns, aging, and various health conditions. You can read messages without logging in. To post a message, please log in or register. It's free...and being a member gives you access to important information. By using the Message Boards, you agree to the Message Boards Policies.

SUBSCRIBE: Sign up to get newsletter with weekly popular topics discussed on the boards  
 

Dealing with OHIP - The Ontario Health Insurance Plan

Dealing with OHIP - The Ontario Health Insurance Plan

Postby LeahFlameRain » Thu Mar 20, 2008 4:56 am

I am placing this in the TT board because many people from Ontario Canada don't know what to ask for when they go to the PS for a TT consult. There is also mention of breast reduction in this post so if any mod feels like I haven't placed it in the right forum, please feel free to move it as the need may be.
The section on Panniculectomy follows after the section on Breast Reduction...

~THANKS!!!

In the province of Ontario Canada, there are indeed some situations in which PS is covered. One such situation is BREAST REDUCTION.

In order to be considered for a breast reduction on the OHIP plan, you must present with significant symptomatology.
This is some of what OHIP considers significant symptomatology in regards to breast reduction.

Firstly be aware that pitosis (sagging) of the breasts is NOT enough to have OHIP cover your reduction surgery. It should be a contributing factor, but as well there should be documented pain in the shoulder or neck regions, bra strap indentations of the shoulder area, skin fissuring in the creases and folds and intertrigo (rashes) associated with excessive and uncontrollable moisture in the folds and cleavage of the breasts.

If you are experiencing ANY of the above symptomatology, MAKE SURE you take yourself to your regular family doctor or in absence of a family doctor to a walk in clinic and report the symptoms to a medical professional and ask for his/her advice on the best way to deal with them.

One of the things that finally pushed me over the edge to surgery was the fact that a year ago I ended up in the ER thinking that I was having some kind of stroke due to numbness in the arm and face, only to find out that I was healthy as a horse, but the nerve compression in my shoulders from lugging around my huge breasts was the problem. It was embarrassing for about 2 seconds until the cardiologist suggested breast reduction to alleviate the symptoms and actually wrote it in her discharge notes for OHIP.

One thing my PS told me is that if you are over a D cup in Ontario the chances are good that you will be approved; having the other symptomatology is like the icing on the cake. So if you are over a D cup, with strap indentations, the chances are good that OHIP will eventually approve your request.

Another situation that may be covered by the OHIP plan is PANNICULECTOMY.

It is important that you know your terminology when you enter into a consult with a plastic surgeon. If you go in asking for a tummy tuck consult that is exactly what you are going to get a cosmetic tummy tuck consultation.

If you go in asking for an OHIP insured panniculectomy consult then that is what you are going to get.

MAKE SURE that you are refferred to your plastic surgeon through your family doctor and that the plastic surgeon works out of a provincially funded hospital. OHIP WILL NOTcover surgeries done in private surgical centers for ANY reason. The surgery and aftercare MUST be in a provincially funded and regulated hospital in order for coverage to be considered.

In researching the procedure it is easy to become confused because the term abdominoplasty and panniculectomy are quite often interchangeable when you are searching online.

In a lot of cases and with a lot of insurance companies they carry the exact same billing code therefore making it very difficult for the companies to determine exactly what procedure you are asking for. Since OHIP never covers a cosmetic tummy tuck, the proper term is panniculectomy for insurance purposes.

Once again, symptomatology is KEY when asking for OHIP to cover a panniculectomy. Rashes, skin fissures, back pain, lower body pain restricted movement, all of these fall under symptomatology for panniculectomy. It is paramount that your symptomatology be recorded.

Do not be ashamed or fearful in going to a general practitioner (family doctor) and asking for ways to manage pain brought on by the weight of the pannus. Don’t be afraid to go week after week, month after month or for every rash, odor or anything “abnormal” all of these visits are recorded and then OHIP has a basis in which to judge your claim.

What is an OHIP insured panniculectomy? The definition of panniculectomy says that it’s the excision of redundant fat and skin below the navel for functional purposes sometimes with and sometimes without preservation of the umbilicus (belly button.)

When I went for my consult I was fully expecting to hear that there would be no muscle repair involved and that I basically would get what I got on the other side of surgery, but that is not what I heard from my PS, instead I heard that there will lipo around my rib cage and there will be a hip to hip incision, and in some cases an inverted T from the belly button to the pubic mound (this will be the case for me as I have an extra paunch there that needs extra work to deal with) there will be placation of the fascia (tightening of the abdominal muscles) and there will be repositioning of the umbilicus ( belly button)….

Now if that doesn’t scream TUMMY TUCK, I don’t know what does. It’s not in what you say to OHIP, but how you say it that makes all the difference.

I was also informed by my PS that OHIP has a habit of denying at least 50% of requests for panniculectomy and they basically do it to see who is serious enough to fight with them over it, so if you receive a denial don’t think it’s the end of the world; it’s just OHIP saying “convince me.”

I was lucky and got my approvals without having to appeal, but when dealing with provincial health insurance remember that it’s not personal, it is their job to make sure that you know what it is you are doing, that you meet the criteria for them to fund the operation and that you are serious about your health and the maintenance of it post operatively.

I have read what I think might be a million messages all over the internet by people saying that OHIP doesn’t cover a TUMMY TUCK… this is true, they don’t cover a TUMMY TUCK because TUMMY TUCKS are believed to be strictly cosmetic, what they do cover is PANNICULECTOMY that is considered medically necessary and reconstructive and if you have all your ducks in a row you should have no problem getting one.
User avatar
LeahFlameRain
 
Posts: 194
Joined: Tue Mar 18, 2008 3:55 am
Location: Ontario Canada



Postby cherone » Thu Mar 20, 2008 5:27 am

Thanks for taking the time to post this excellent info. There are sure to be many Ontarians on this board who could benefit from this.
:D
http://www.makemeheal.com/pictures/view ... bumid=5087
[url=http://www.TickerFactory.com/]
Image
[/url]
cherone
 
Posts: 60
Joined: Mon Jan 28, 2008 8:05 am
Location: Sarnia, Ontario



Postby LeahFlameRain » Thu Mar 20, 2008 5:42 am

No problem! I know that when I was looking for info it was almost impossible to get anything on OHIP approvals so I thought sharing what I now know might make it easier for someone else.
User avatar
LeahFlameRain
 
Posts: 194
Joined: Tue Mar 18, 2008 3:55 am
Location: Ontario Canada



ohip covered tummy tucks

Postby megan25 » Tue May 12, 2009 2:56 pm

Hi there.

i was just wondering who the surgeon was that did your tummy. my doc refered me to a doctor Adams and he said that he would not do it and that he didnt know any doctor that would do it covered by ohip. :cry:
megan25
 
Posts: 1
Joined: Tue May 12, 2009 2:51 pm



Products That Customers Interested in This Topic Are Buying


Postby ellcie » Wed May 13, 2009 5:59 am

Wow...I had no idea.
Even if I had known that pre-op though, I wouldn't have qualified. I didn't have enough skin/fat to cause symptoms. Wonder how many symptomatic women have paid for it all themselves when it might have been covered........
Thx for your post
Perhaps you've informed someone who can now benefit from the info
http://www.makemeheal.com/pictures/view ... bumid=9313.

password=hereiam
MTT/MR/BA Sept 7'07
FTT/MR Apr 27'09
User avatar
ellcie
 
Posts: 353
Joined: Wed Oct 03, 2007 7:51 pm



THANK YOU LeahFlameRain

Postby bridget-ann » Tue Jun 02, 2009 5:49 pm

THANK YOU LeahFlameRain for posting that

From your post it was over a year ago so does anyone know if OHIP will still cover it

and what is the reason for them to cover it? and how do you go about asking your family doctor for a referral?

My history:

15 years of back pain on and off, the last 6 years very bad very bad low back pain, to the point I can not walk or stand up I spend about 2-3000 a year at least on Chiropractor, my husband is self employed we do not have any extra insurance to help pay it

pain goes down my legs, also low stomach pain, stomach muscle are gone due to 3 kids in 3 years at age 20-23 and hysterectomy at 29 for medical reasons, I do get very sore itchy rash all the time

I also get stomach cramps a lot and very bad bloating after eating

Life just crap as I am very limited to what I can do

I’m visiting my doctor with pain at least 2 3 times a month

Also my breast are a 42 H cup pain in neck and shoulders all the time, bra straps digging in
I am over weight and have been trying to loose for over 5 years with my doctors help but it don’t seem to shift at all in January I was at my heaviest of 268lbs I'm now down to 218lbs but don’t seem to loose any more and to be honest all my weight is in my belly and boob area

do you think I would qualify for this to be done on OHIP and if I am how long will it take to be approved, I'm really at my wits end now I've really had enough going to talk to my doctor this week

THANK YOU IF YOU READ THIS

Bridget
bridget-ann
 
Posts: 1
Joined: Tue Jun 02, 2009 5:28 pm



Postby Bodatious » Sat Jun 06, 2009 4:19 pm

Leah is soooo right it depends on how your dr submits the information to your insurance company it truly is all in the wording and how much documentation you have to support your claim...bridget-ann it appears that you have documentation to support your claim talk to your primary care dr and see what they say also consult with a ps and get their input as well...another thing you will have to find a ps thats good and one that has experience in fighting insurance companys because this can become quite time consuming and not all ps are going to battle with your insurance company...good luck to you
Bodatious
 
Posts: 48
Joined: Sun May 31, 2009 7:05 am
Location: Maryland



Re: Dealing with OHIP - The Ontario Health Insurance Plan

Postby FERGUSSCOT » Sun Mar 20, 2011 12:31 am

Hi LeahFlameRain I am in a similar position to you. I thought one of the criteria for getting a PANNICULECTOMY was losing 100 lbs or more. I like you have a large abdominal flap. I have a severe back problem and would like a breast reduction too. My doctor wishes me to have both done but she has not been able to find a plastic surgeon who does hospital OHIP work. :o . Any suggestions where she can find a plastic surgeon who will operate in a hospital and where I'll be covered? I'm a senior citizen too so I don't have a lot of money.

Thanks for all your tips and I will try and do some more research on my own as well.
FERGUSSCOT
 
Posts: 3
Joined: Sun Mar 20, 2011 12:01 am



Re: Dealing with OHIP - The Ontario Health Insurance Plan

Postby FERGUSSCOT » Sun Mar 20, 2011 12:31 am

Hi LeahFlameRain I am in a similar position to you. I thought one of the criteria for getting a PANNICULECTOMY was losing 100 lbs or more. I like you have a large abdominal flap. I have a severe back problem and would like a breast reduction too. My doctor wishes me to have both done but she has not been able to find a plastic surgeon who does hospital OHIP work. :o . Any suggestions where she can find a plastic surgeon who will operate in a hospital and where I'll be covered? I'm a senior citizen too so I don't have a lot of money.

Thanks for all your tips and I will try and do some more research on my own as well.
FERGUSSCOT
 
Posts: 3
Joined: Sun Mar 20, 2011 12:01 am



Re: Dealing with OHIP - The Ontario Health Insurance Plan

Postby padeena » Sun Mar 20, 2011 4:50 am

Am I right in assuming that OHIP is medicare?
I find it difficult to believe that your dr can't find a PS that does OHIP work. Any large hospital would have to have several PSs on staff. If we have them here in NB, surely you have them in ON! Maybe there are enough private clinics that it is rare for a hospital PS to have to do that kind of work.
Padeena

[url=http://www.TickerFactory.com/]
Image
[/url]


*********************************
PICS UPDATED APRIL 22/11

http://www.makemeheal.com/pictures/tumm ... oss-a12334
User avatar
padeena
 
Posts: 263
Joined: Fri Jan 28, 2011 4:42 pm



Re: Dealing with OHIP - The Ontario Health Insurance Plan

Postby padeena » Sun Mar 20, 2011 4:50 am

Am I right in assuming that OHIP is medicare?
I find it difficult to believe that your dr can't find a PS that does OHIP work. Any large hospital would have to have several PSs on staff. If we have them here in NB, surely you have them in ON! Maybe there are enough private clinics that it is rare for a hospital PS to have to do that kind of work.
Padeena

[url=http://www.TickerFactory.com/]
Image
[/url]


*********************************
PICS UPDATED APRIL 22/11

http://www.makemeheal.com/pictures/tumm ... oss-a12334
User avatar
padeena
 
Posts: 263
Joined: Fri Jan 28, 2011 4:42 pm



Re: Dealing with OHIP - The Ontario Health Insurance Plan

Postby FERGUSSCOT » Mon Mar 21, 2011 3:27 pm

It appears to be that way. It's hard to find any PS dept in Hospitals, I don't know why? It's just that so much PS is not covered by OHIP I think.
FERGUSSCOT
 
Posts: 3
Joined: Sun Mar 20, 2011 12:01 am



Re: Dealing with OHIP - The Ontario Health Insurance Plan

Postby np224 » Tue May 17, 2011 10:23 am

I live in the GTA area and a few years ago got a breast reduction done covered by OHIP, there are docs out here that will do it and will (could) be covered. I'm now on a mission to my tummy done... My sister lives in Brantford and has had her tummy done and is getting her breast done next year and both are covered my OHIP, so I don't think your doctor knows what he's talking about.

Good luck
np224
 
Posts: 1
Joined: Tue May 17, 2011 10:10 am



Re: Dealing with OHIP - The Ontario Health Insurance Plan

Postby freespiritha » Thu May 26, 2011 7:16 pm

Hi there. I am seeing dr. Jugenburg in Toronto re br covered by Ohip and my friend is seeing him for pennilectomy
2007 tt in Canada
2009 lapband in Canada
2011 lipo and bbl in TJ with Dr Carmina Cardenas
2012 revision tt, tl, al more bbl with Dr Cardenas
2012 breast reduction Canada
2013 Removed lapband
2014 Vertical sleeve with Dr Filipe Garcia...bad experience
freespiritha
 
Posts: 2426
Joined: Tue Jun 05, 2007 4:14 pm
Location: London, Ontario



Re: Dealing with OHIP - The Ontario Health Insurance Plan

Postby freespiritha » Thu May 26, 2011 7:17 pm

Hi there. I am seeing dr. Jugenburg in Toronto re br covered by Ohip and my friend is seeing him for pennilectomy
2007 tt in Canada
2009 lapband in Canada
2011 lipo and bbl in TJ with Dr Carmina Cardenas
2012 revision tt, tl, al more bbl with Dr Cardenas
2012 breast reduction Canada
2013 Removed lapband
2014 Vertical sleeve with Dr Filipe Garcia...bad experience
freespiritha
 
Posts: 2426
Joined: Tue Jun 05, 2007 4:14 pm
Location: London, Ontario



Products That Customers Interested in This Topic Are Buying


Next

Return to Tummy Tuck, Abdominoplasty

 

Featured Specialists









Top Cleveland Plastic Surgeon
Look Young Again!
Experienced & Compassionate
www.DrBramKaufman.com

Miami Plastic Surgery
Board Certified Surgeons
Breast Augmentation $2800
coralgablescosmetic.com