OHIP QUESTION @PS

I had posted here a few days ago, about the PS here in Northern Ontario Not even submitting to OHIP for pannus removal, they will only deal with TT out of pocket pay. I went to my doctor and asked to be referred to another PS who I know will at least submitt for the pannus removal, but they are in the Ottawa area. The drs  said I couldn't. They said because I live in Northern Ontario I have to deal with a PS here. I can't understand if the PS here is unwilling to even try and submit it, then am I not entitled to another opinion? The office said that if I do not go to the PS here, it will look like I am uncompliant? This seems crazy to me? I feel trapped, and am being forced to either forget about the surgery or just pay out of pocket. I would love to know if anyone out there knows the rules about this....

thanks,

N

I would get a referral to the doctor you want.  You have the right to have a doctor you feel comfortable with. 

Quite frankly, if the doc in northern ontario doesn't take OHIP (you said you'd have to self pay), then why would you get a referral for something that wouldn't be covered anyway.  It doesn't make ANY sense at all.  

You get a referral for a PANNI.  If a doctor there won't do a referral for a panni, insist that you want a panni so you need a referral for a PANNI.  (Don't mention tummy tuck til you are in the surgeons offic anyways because a refersl for a TT would not be covered.)

Hi Dawn, thanks for the reply....it my family doc that said I can't get another referral, so I don't know what to do? I know it doesn't make any sense? 

Ask your Centre to refer you.  Mine did.  It's another route you can try. 

Did you already use that referral (visit)?  I could understand that you may only get one paid referral.  You might need to self pay.  

When the PS called about an appointment that's when I found out they wouldn't even submitt, I then called my drs and asked to have a new referral, that's when they said no that I have to go to this guy or it would be me being non-compliant....the funny thing is when I originally asked for the referral I wanted this guy in Ottawa, but my dr said I had to go to someone in my area! and now because I listened, I feel like I'm getting screwed...

Did you talk to him about an Ohip funded panni specifically?  I'd try to explain that if he doesn't understand that or do like someone else said and get a referral from someone else.  The whole situation  is ridiculous.  

I specifically asked when they called about the referral and they stated, they don't submit any OHIP skin removals or panni's they strictly do TT. I will have to look into my centre for sure! Thanks ladies...

Your whole situation with this is ridiculous. You have the right (yes, RIGHT) to be referred to any plastic surgeon you choose, regardless of their location. Figure out which PS you would like to have a consult with and have your GP refer you. It's not up to anyone but you.

I have an excellent PS in the west Toronto area, PM me if you would like his information. I had no trouble at all being approved (through his office) for a panniculectomy last year. I did not have a tummy tuck, just the panni. Quick approval from OHIP.

Karen

I sent you a Pm