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For Those in Ontario Canada

For Those in Ontario Canada

Postby LeahFlameRain » Wed Jun 25, 2008 4:02 am


BEFORE YOU ASSUME THAT YOUR TT IS NOT COVERED READ BELOW


I decided to go on a search to make things a little easier for those in my province. Although we have a social health care system, it is sometimes rather hard to get access to the information we need in regards to what is and is not covered.
This is how you start the process to see if OHIP will cover your TT ( called a PANNICULECTOMY)

First and foremost take pictures! Take pictures of rashes and skin cracks, fissures and anything that you know isn't "normal"

Second... COMPLAIN... go to your family doctor and if you don't have one ( because we have a severe shortage of primary care physicians in Ontario) go to your local walk in clinic... ASK when the doctor you are seeing is scheduled to work and make sure you go back to him/her so that he/she becomes familiar with your situation. Don't forget that when you see them it is billed to OHIP and OHIP will have a record of how many times you were treated and/or seen for the same symptomatology.

Third (and this is IMPORTANT) DO NOT PAY OUT OF POCKET FOR A CONSULTATION!
Go to your primary care physician and ask for a referral to a plastic surgeon! OHIP will pay for this consult. In fact I wrote the Ministery of Health office and was assured that they would pay for as many consults as I felt I needed. I saw two plastic surgeons for consult and OHIP paid for both.

Don't let a plastic surgeon or any other doctor tell you that this is not an insured service. Don't let them tell you that it is just the removal of skin... that's not true!

Below I have copied the billing codes and what they are for

Panniculectomy
# S318 - includes any necessary diastasis repair
# E748 - with repair of umbilical hernia
# S319 Mesenteric cyst

Here is the policy on revisions post operatively;

Revision, because of undesirable results, of a surgery, which was originally performed for alteration of appearance, is an insured service only if the original surgery was an insured service and if the revision either is part of a pre-planned staged process or occurs within a reasonable period of convalescence. Prior authorization is required only when the original surgical procedure, if it had been carried out at the time of the proposed revision, would have required such authorization.

**reasonable period of convalescence is considered to be two years**


Hope this helps anyone in Ontario that has been thinking about TT but wasn't sure how to go about it.
If you have any questions feel free to ask me or PM me if that would make you more comfortable.
TA TA's and TUM TUM! UPDATED June 23 2008!
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Postby Sharm » Wed Jun 25, 2008 5:48 am

thanks.. i have not been to my family doc about this I just went and called for a free consultation.... i doubt it would be covered but you think it could be ?
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Postby LeahFlameRain » Wed Jun 25, 2008 5:57 am

If you are in Ontario and request a referral from your family doctor to a plastic surgeon OHIP will pay for the consultation.

You can still choose any surgeon that works under the OHIP system ( that means that they have to work with or out of a publicly funded hospital)

For instance... my PS has two private practices, but also works out of the Scarborough General Hospital, is on staff there and has full hospital privileges.

If the consult you booked is free, then I say go to it and ask about them submitting to OHIP, the worst they can say is no, and then you have the option of going through your family doctor.

My first consult was with a doctor in my city, he turned out to be an arrogant, insensitive ass.
My second consult was with a doctor of MY choosing that came highly recommended by a friend of mine who had her TT and BR covered the year before.
As soon as he saw my boobs he knew I'd be covered. Apparently OHIP will cover pretty much anything above a D cup

With the belly he said it's a 50-50 split, but told me if I was denied to appeal it.
I was approved with no questions asked, even though I was prepared to fight it.

My PS said that OHIP denials are given 99% of the time just to see who is going to fight and who is willing to drop it.
OHIP wins if you drop it, they save cash that way. If you fight it they are inclined to know that you are serious and know what it is you are talking about when it comes to your health and well being.
TA TA's and TUM TUM! UPDATED June 23 2008!
http://www.makemeheal.com/pictures/view ... bumid=5634

CLOTHES! UPDATED June 23 2008!
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Postby victoriabella » Sat Jun 28, 2008 6:11 am

What is the difference between a PANNICULECTOMY and a TT? I had to pay for my consult $85. We took pictures and submitted to OHIP and I also wrote a letter to them. I was born a premie with a colostomy, burst bowel, ruptured appendix and thus was left with a pretty nasty looking tummy. I am getting a little frustrated because OHIP wanted more info but PS office did not fax the reply when I called earlier in June... So thinking it may not happen. This consult was in Niagara Falls. I have another consult but that is Sept 24th in Hamilton. I am a student so I may postpone till next summer....

Thanks so much for posting this info Leah :)
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Postby Taratallen1975 » Sat Jun 28, 2008 6:22 am

Hey Leah,

Do you know if OHIP will cover a BR more than once? I had my BR done in Feb/07 and went from DD/E to C and now since TT they have grown back to a small D :( (I haven't gained weight so what the heck?)

I do NOT want to be bigger than a C and I'm thinking if my boobs keep growing I'm going to end up as big in the chest as I was pre BR :(

Thanks for the help,
Tara
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Postby LeahFlameRain » Sat Jun 28, 2008 7:43 am

Taratallen1975 wrote:Hey Leah,

Do you know if OHIP will cover a BR more than once? I had my BR done in Feb/07 and went from DD/E to C and now since TT they have grown back to a small D :( (I haven't gained weight so what the heck?)

I do NOT want to be bigger than a C and I'm thinking if my boobs keep growing I'm going to end up as big in the chest as I was pre BR :(

Thanks for the help,
Tara

i would definitely go and find out. There is rare instance of breast re-growth after reduction and it seems that the only real solution for that is to do free nipple grafting. I don't know exactly why that seems to be the thing that works.

I asked the re-growth question to Dr. B ( on his board) a while back and he said that there is a small percentage and that includes those over 35.

It was something I was freaking out about when my boobs started dropping and fluffing out a bit... I was worried that they were growing back so I did some research via the net and some plastic surgery journals.

Usually it happens in younger women, but it's not something that is exclusive to the younger set.
TA TA's and TUM TUM! UPDATED June 23 2008!
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Postby Sharm » Sat Jun 28, 2008 7:49 am

Boobs prob look bigger because your tummy is smaller.... i had a BR years ago... now i am a C40 well that even seems abit small but i dont care..they could use a lift though BLAH
i was reading the diff between the two not much same procedure etc.. except a TT has Toning and a pann............ does not it just removes skin and fat where a TT does that plus tones up the muscles.... just google it you'll get lots of info :D so depend what your looking to get..
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Postby LeahFlameRain » Sat Jun 28, 2008 8:09 am

Sharm wrote:Boobs prob look bigger because your tummy is smaller.... i had a BR years ago... now i am a C40 well that even seems abit small but i dont care..they could use a lift though BLAH
i was reading the diff between the two not much same procedure etc.. except a TT has Toning and a pann............ does not it just removes skin and fat where a TT does that plus tones up the muscles.... just google it you'll get lots of info :D so depend what your looking to get..


This is where you are wrong! Muscle repair is done with panniculectomy in the province of Ontario where it is warranted.

see below

Below I have copied the billing codes and what they are for

Panniculectomy
# S318 - includes any necessary diastasis repair <--- THIS IS MUSCLE REPAIR AND I HAD IT!
# E748 - with repair of umbilical hernia
# S319 Mesenteric cyst

In fact I had a lipo assisted panniculectomy with muscle repair and replacement of the umbilicus AND repair of a small hernia in the upper abdomen.

I also had lipo assisted breast reduction with areola reduction.

Now when I am closer to my idea body weight ( and I mean idea for me and not what the "experts" say) I will most likely have to have a second skin removal from the lower tummy and that will be strictly panniculectomy.
TA TA's and TUM TUM! UPDATED June 23 2008!
http://www.makemeheal.com/pictures/view ... bumid=5634

CLOTHES! UPDATED June 23 2008!
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Postby kathybad » Fri Aug 01, 2008 8:31 pm

Thanks for the info. I had never heard about OHIP covering a BR. I'm a DD cup, but shrinking due to weightloss. Does the BR also include a lift, and how would I go about this process?
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Postby LeahFlameRain » Sat Aug 02, 2008 3:59 am

kathybad wrote:Thanks for the info. I had never heard about OHIP covering a BR. I'm a DD cup, but shrinking due to weightloss. Does the BR also include a lift, and how would I go about this process?


i wish mine had shrunk with my weight loss but they stayed the same... *sigh*

anyhow you have to go to your family doctor and get him/her to refer you to a plastic surgeon, then when you are at the consult with the plastic surgeon make sure you tell him/her that you want to apply with ohip to see if they will cover.

my PS said they usually cover anything DD and over but that largely depends on your frame as well... mine were lifted and my nipples actually point outward instead of down now... I love my breasts now and before used to have a hate relationship with them especially when it came time to find something to wear to a formal function.
TA TA's and TUM TUM! UPDATED June 23 2008!
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Postby threenorns » Tue Aug 26, 2008 11:21 pm

hi - i live in toronto. i'm at the start of a very large weight loss - third time around. this time, however, i'm 20yrs older and have a 17mo old baby and i can tell it's gonna get ugly.

before i was pregnant, i was powerlifting and reducing bodyfat. i was 180 and a size 12 and looking rather good - but i could see the skin on my thighs starting to accordion. now i have a 17mo old baby and 5mo bed rest played bloody havoc. i am right back where i started, with about 100lbs to lose. now i am freaking out that i'm going to look like i melted after i've lost the excess weight!

someone told me she had excess skin removed from her stomach, thighs, and upper arms after she lost 120lbs and it was covered by OHIP because she lost 100lbs or more. do you know, if it was ever true, if it still is? i've been trying to find information but you know what that's like. i think i'll be looking at tummy tuck/repair and excess skin removed from thighs. i have a rather large tattoo on my chest that would be demo'd if i had a lift so anything done to my bust would be limited to an implant to try and pick up the slack, as it were - i'm *huge* right now (H or I), but only because i'm nursing. once she weans, i drop right back down to a B and man, that's nasty. National Geographic.
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Postby LeahFlameRain » Wed Aug 27, 2008 1:31 am

threenorns wrote:hi - i live in toronto. i'm at the start of a very large weight loss - third time around. this time, however, i'm 20yrs older and have a 17mo old baby and i can tell it's gonna get ugly.

before i was pregnant, i was powerlifting and reducing bodyfat. i was 180 and a size 12 and looking rather good - but i could see the skin on my thighs starting to accordion. now i have a 17mo old baby and 5mo bed rest played bloody havoc. i am right back where i started, with about 100lbs to lose. now i am freaking out that i'm going to look like i melted after i've lost the excess weight!

someone told me she had excess skin removed from her stomach, thighs, and upper arms after she lost 120lbs and it was covered by OHIP because she lost 100lbs or more. do you know, if it was ever true, if it still is? i've been trying to find information but you know what that's like. i think i'll be looking at tummy tuck/repair and excess skin removed from thighs. i have a rather large tattoo on my chest that would be demo'd if i had a lift so anything done to my bust would be limited to an implant to try and pick up the slack, as it were - i'm *huge* right now (H or I), but only because i'm nursing. once she weans, i drop right back down to a B and man, that's nasty. National Geographic.


Ohip does cover excess skin removal... they do cover what they call medically necessary panniculectomy. Most of what you read on the net will indicate that panniculectomy is strictly flap removal, but I'm living proof that it's not true. Ontario coverage includes skin removal and muscle repair.
Unfortunately "sagging" of the breast is not enough to qualify for a reduction or lift of the breasts, there must be "significant" symptomotology associated with the ptosis ... they consider those symptoms to be neck, back and shoulder pain. Shoulder strap indentations as well as rashes and other skin issues.
As for arm lifts and thigh lifts... I'm not entirely sure what is and isn't covered.
I lost all totaled now about 150... I was at 110 when I went for my consult and dropped another 30-40 pre-op at my surgeon's request had about 15lbs of excess skin removed between my breasts and my tummy and have lost about another 15 since surgery. I don't go by the scale however, I go by clothes and how they fit. I refuse to be a slave to the pound indicator on the scale... not good for me mentally.
Three years ago I was a 48F The day of my surgery I was a 36F( maybe even a G because there was some spillage of cleavage going on)
Now at 5ish months post op I am a 34C/D depending on the bra.

My surgeon is at the Scarborough general. One other criteria OHIP has is that the surgery MUST be done at a provincially funded hospital.
If/when you're ready and would like his info just shoot me off a private message and I will forward his referral details to you if you'd like.
He's a no-nonsense shoot from the hip type guy who is 150% serious about his work. I love him to death.
TA TA's and TUM TUM! UPDATED June 23 2008!
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Postby TammyLyn » Wed Aug 27, 2008 3:26 am

Leah ... where were you and all this wonderful info a year or so ago!! lol I've had quite a few people ask me about OHIP coverage for this ... I had thought about it but figured I just wanted to have it done!

Thanks for the info though for those looking... and so I can pass it on :)
First TT Nov 29/2007

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Postby miffymoo » Wed Aug 27, 2008 5:32 am

Wish I had seen this before I had surgery!! I do know that OHIP covers BR. I know many women who have had it done and all were covered by OHIP. You just need your doc behind you.
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Re: For Those in Ontario Canada

Postby GConlon » Wed Jun 08, 2011 1:02 pm

I an new to the forum, living in NW Ontario. I was referred to a PS in January for a consult for a panni. My flap happened after having my kids, I am now having recurring yeast infections. Being diabetic, these infections could lead to more serious problems.

It is now June and OHIP still has not given a decision one way or the other, I called my PS office today and was told in March they sent a form requesting more information, which my PS provided them. The receptionist told me in view of their request she doesn't think they will cover the surgery.

She didn't sound very optimistic, said she would call them and see if she could find out anything and I could call her in a few weeks to find out if she got any answers. When I had the consultation, the PS told me it would take about six weeks to get approval, call the end of February and his receptionist would set up a surgery date. It will be six months on July 8th, still no answer and now his receptionist feels it won't be approved.

I am beyond frustrated at this point, and the yeast infections keep on happening.
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