Expert: Diminishing Dawn - 12/12/2008

Question
Very recently, OHIP decided to reject coverage for the Mini-Gastric Bypass procedure. Do you have any idea why? I am curious if they are rejecting that particular procedure that they had often funded in the past, or because it is performed in the US and not Canada, or is it a reluctance to fund bariatric surgeries in general? Thank you so much in advance for your time.

Answer
MGB has been covered for a long time. If you are referring to the issue of it being very recently not covered (like literally weeks) this is because bariatrics in Canada have now received more funding.  

OHIP is clamping down now on all out of country procedures. Unless it is an emergency and you have a valid reason as to WHY you have to have the mgb --such as one that would make sense medically, OHIP is now refusing all OOC applications.  If you don't have the boxes on the 2nd page checked, you MUST have surgery in this country.

OHIP originally deemed out of country as for emergency patients. Over the years, the criteria loosened so that just about anyone could go out of country. Now they are bringing more bariatrics to Canada and making people choose Canada by denying the other procedures. They want all WLS patients to be pretty much channelled into the RNY procedure being done in Toronto, Guelph and now Hamilton. Hamilton just got the funding for their hospital at St. Joe's under Dr. Anvari.

IF I can be of any assistance let me know...but yes OHIP and their rules are completely changing now.

Dawn