Need to make a convincing case to the surgeon
So I have decided to get a DS with Dr. Gagner and I am trying to convince my provincial health insurance to pay for it. In Ontario, the provincial health insurance (OHIP) will pay for RNY for anyone within the usual guidelines, 35+ BMI with co-morbids and 40+ BMI. It will also pay for a VSG for anyone with the same criteria who cannot have RNY due to a medication issue, prior abdominal surgery, etc.
For the DS though, it is a lot trickier - only a handful of people have been approved in the past two years and they all fall into one of two categories: revisions, or 50+ BMI. I fit neither of these categories.
There is one DS specialist in the public health care system in Ontario and he is the one who decides who gets approved. He is very pro-DS for SMO and revision patients, but I don't know his opinion about those under the 50 BMI threshold, as he is also constrained by what OHIP will pay for. (FYI - When patients are approved, they are typically sent to Dr. Gagner for surgery as there is a backlog of RNY patients and the Ontario surgeon is able to do more of those surgeries, more quickly.)
I am a 42.5 BMI going for my first (and only!) surgery. I spent months on this board listening and learning and reading research papers and I am sure that the DS is the most appropriate surgery for me. I have health problems (anemia on and off due to bleeding problems, need to take NSAIDs) that make the RNY a poor choice for me and I don't want a VSG when there is no long term data on it, and I'm convinced that my broken metabolism and need to take medication that causes weight gain simply requires a surgery with malabsorption. I'm 27 so I have to be very concerned about the LONG term.
I plan on bringing my binder of research that lead to my making this decision, but I know surgeons don't have a lot of time and I only have a 20 minute appointment with him. So my question is - how would you handle the appointment? I'm thinking of making a one page summary to give to him and then elaborate on each point. The point I want to drive home is that I don't believe any other surgery is appropriate for me, and waiting to see a failed VSG or weight gain until I hit a 50 BMI (which on my current trajectory is inevitable) before allowing me a DS is unethical and unsupported by the medical literature.
If anyone has any ideas on how best to approach the consult with the surgeon, I'd appreciate your input.
PS - if I'm denied by the surgeon, I won't be appealing. The OHIP Appeal Board is strictly in the business of ensuring that the current positions are appropriately enacted, so it's the surgeon who has more discretion.
For the DS though, it is a lot trickier - only a handful of people have been approved in the past two years and they all fall into one of two categories: revisions, or 50+ BMI. I fit neither of these categories.
There is one DS specialist in the public health care system in Ontario and he is the one who decides who gets approved. He is very pro-DS for SMO and revision patients, but I don't know his opinion about those under the 50 BMI threshold, as he is also constrained by what OHIP will pay for. (FYI - When patients are approved, they are typically sent to Dr. Gagner for surgery as there is a backlog of RNY patients and the Ontario surgeon is able to do more of those surgeries, more quickly.)
I am a 42.5 BMI going for my first (and only!) surgery. I spent months on this board listening and learning and reading research papers and I am sure that the DS is the most appropriate surgery for me. I have health problems (anemia on and off due to bleeding problems, need to take NSAIDs) that make the RNY a poor choice for me and I don't want a VSG when there is no long term data on it, and I'm convinced that my broken metabolism and need to take medication that causes weight gain simply requires a surgery with malabsorption. I'm 27 so I have to be very concerned about the LONG term.
I plan on bringing my binder of research that lead to my making this decision, but I know surgeons don't have a lot of time and I only have a 20 minute appointment with him. So my question is - how would you handle the appointment? I'm thinking of making a one page summary to give to him and then elaborate on each point. The point I want to drive home is that I don't believe any other surgery is appropriate for me, and waiting to see a failed VSG or weight gain until I hit a 50 BMI (which on my current trajectory is inevitable) before allowing me a DS is unethical and unsupported by the medical literature.
If anyone has any ideas on how best to approach the consult with the surgeon, I'd appreciate your input.
PS - if I'm denied by the surgeon, I won't be appealing. The OHIP Appeal Board is strictly in the business of ensuring that the current positions are appropriately enacted, so it's the surgeon who has more discretion.
I can send you a copy of the appeal letter that I sent to the insurance board with my arguments for the DS. I do not know how to advise you for the Canadian system. I would think that you need to understand the workings of the DS completely and and demonstrate that you would be capable of a life long commitment to the supplements necessary for continued health. Send me you personal e-mail and I will send you my letter. Good luck.
~Gail R~ high wt.288, surg wt 274, LW 143, CW 153, GW164
Most Active
Recent Topics
