Another Canadian considering Surgery

[OttawaAreaLady 0]

Hi all:

I'm joining here in hopes to find posts from other Ontario people who have had the lap band surgery.

I am very seriously considering having it done, but it looks like no one in Ottawa does the surgery so I may be Toronto bound.

I contacted CIBO in Toronto and have spoken to them a bit, and they tell me the price is $18,000 and OHIP will not pay.

However, I called OHIP and was told that if it's a medical necessity they will pay.

I have to see my Dr in a couple weeks for a check up and am going to talk to him about it.

I have a great Dr, and he's been treating me for some time now for High Blood pressure as well as trying to help me with my weight so I'm hoping he will back me up on this.

I've been yoyo dieting since I was in my teens and it's the same old story as with many others, tried everything, keep gaining more each time, etc. etc....

So have any others here been able to get OHIP to pay for the surgery? I can't afford it on my own, but coming from a family of severely overweight people, I'm terrified that as I get older it's only going to get worse for me if I don't have the surgery.

[so done with it all 1]

OHIP does not pay for lap-band at all. They pay for other weight loss surgeries though. If you specifically asked for lapband then you were misinformed because it's right in their schedule of benefits that gastric banding is not covered. They cover gastric bypass, duodenal switch and vertical sleeve gastrectomy only.

[susieq321 31]

Hi all:

I'm joining here in hopes to find posts from other Ontario people who have had the lap band surgery.

I am very seriously considering having it done, but it looks like no one in Ottawa does the surgery so I may be Toronto bound.

I contacted CIBO in Toronto and have spoken to them a bit, and they tell me the price is $18,000 and OHIP will not pay.

However, I called OHIP and was told that if it's a medical necessity they will pay.

I have to see my Dr in a couple weeks for a check up and am going to talk to him about it.

I have a great Dr, and he's been treating me for some time now for High Blood pressure as well as trying to help me with my weight so I'm hoping he will back me up on this.

I've been yoyo dieting since I was in my teens and it's the same old story as with many others, tried everything, keep gaining more each time, etc. etc....

So have any others here been able to get OHIP to pay for the surgery? I can't afford it on my own, but coming from a family of severely overweight people, I'm terrified that as I get older it's only going to get worse for me if I don't have the surgery.

Lapband is exclusively excluded from the OHIP schedule from benefits with a vote in the Ontario legislature in Dec 07 I think. This means that it won't be considered for coverage etc. This was part of a article in the Globe and Mail back then where people were fighting to get partial coverage. Good thing if you are military I can think of two people the cdn forces have paid for the band for as part of a need for their position in the forces.

Heather

[OttawaAreaLady 0]

Yes, I specifically said "Lap Band" surgery, and was told that they would for medical purposes if recommended by a dr.

[OttawaAreaLady 0]

Lapband is exclusively excluded from the OHIP schedule from benefits with a vote in the Ontario legislature in Dec 07 I think. This means that it won't be considered for coverage etc. This was part of a article in the Globe and Mail back then where people were fighting to get partial coverage. Good thing if you are military I can think of two people the cdn forces have paid for the band for as part of a need for their position in the forces.

Heather

Knew I should've joined the forces. lol

[OttawaAreaLady 0]

OHIP does not pay for lap-band at all. They pay for other weight loss surgeries though. If you specifically asked for lapband then you were misinformed because it's right in their schedule of benefits that gastric banding is not covered. They cover gastric bypass, duodenal switch and vertical sleeve gastrectomy only.

From what I've been reading, lap-band surgery is much less invasive and safer. Does anyone know why they would pay for other types and not lap band surgery?

[susieq321 31]

From what I've been reading, lap-band surgery is much less invasive and safer. Does anyone know why they would pay for other types and not lap band surgery?

Now when you said lap band they may have confused it with the VGB which is covered and it is a banding but none adjustable and many of the people who have this find it difficult to maintain the loss long term without the adjustbility.

As to why it isn't covered many many reasons the big one is you have to understand how OHIP works and why the legislature did what they did in voting to not have it covered.

My understanding of OHIP is thus (I am not a Dr I am a software consultant so my knowledge may be wrong)

OHIP has a committee that meets to discuss what is and is not covered a few times a year and that committee is made up of Drs, so this committee adds things to the fee schedules and takes them aways gives more money equating to time to procedures that are covered or less.

So to get something covered you need to apply to this committee to get it covered only Docs can apply to the committee and none of the banding surgeons want the band covered for many reasons so none of them will ever apply.

Some of the reasons they don't want the band covered is that it would be just another WLS so it be slotted under that umbrella and the wait for RNY is huge with some Drs less with others who work in WLS hospitals who dedicate more OR time to WLS.

So part of the reason is their are afraid the wait would be huge

There would be no post op clinic follow up they way we have now, no fill nurses etc because OHIP won't cover lectures, websites, etc.

The docs also make a nice living from banding and OHIP would not pay nearly as much as private practice does so it would cost the private banding docs money.

Now why the ON legislature voted not to cover it, there was a law suit which cost a lot of money and they wanted to avoid the possibility of another law suit so the voted to permanently exclude adjustable gastric banding (which is what you would need to ask about when you call)

Heather

[OttawaAreaLady 0]

Interesting. So if you had not been able to pay for your lap band surgery, what would you have chosen?

I'm afraid, I may not have a choice, but to go with one of the covered surgeries, as I don't have the money to put down, nor can I afford the payments.

[susieq321 31]

Interesting. So if you had not been able to pay for your lap band surgery, what would you have chosen?

I'm afraid, I may not have a choice, but to go with one of the covered surgeries, as I don't have the money to put down, nor can I afford the payments.

There are other options be prepared to be on a waiting list that may be months up to five years.

I am unusual I at the time I was banded had US health coverage since I am a CDN who works in the US much of the time so I had several options covered under my US health care ironically none of those was the band since it had not been approved in the US yet. I saved and took the money out of what I had been saving for my house down payment. Others have done it many other ways.

But I would put myself on the waiting list for the sleeve or RNY if I knew there was no way I could ever pay for the band.

Heather

[so done with it all 1]

If you go to OHIP's Schedule of Benefits and look at S120, it states that bariatric surgery is covered except for gastric banding. They specifically exclude it.

If I couldn't have afforded the band, I'm not sure if I would have opted for any other option since it was the only one I was comfortable living with long term. If you want to do more research on each of the procedures that are covered, I would recommened joining ObesityHelp - Gastric Bypass, LAP-BAND and going to the Ontario forum. Almost everyone on there had OHIP covered procedures both in country and out of country. Lots apply for OOC since the wait lists are so long in Ontario.

I think the procedure you choose depends a lot on how much weight you want to lose and what you are willing to live with. Each surgery requires different post op guidelines and you have to be able to live with those. Some of the surgeries have malabsorption issues and you have to know that you are the type of person that will diligently take your Vitamins daily.

[OttawaAreaLady 0]

Yes, I agree with what you say. Not only am I not comfortable with the other options, but it's crazy how long one has to wait to get the surgery.

Going out of the country is not something I want to do, either, so I'm afraid I'm out of luck.