Expert: Diminishing Dawn - 10/3/2009

Question
i live in Ontario and i have researched gastric bypass roux en y procedure.i am planning to have the surgery done in michigan.i am not sure if i qualify for preapproval from ohip.i am 54 years old and my MI is 39.9.i have other medical problems due to my weight.i have type 2 diabetes which i am on 2 types of insulin and oral diabetes meds.i have high blood pressure,high cholesterol,tmj, bladder problems,joint pain from arthritis,back problems.what concerns me is that i won't be accepted because i have my diabetes under great control and my high blood pressure and cholesterol are controlled as well with meds.i walk everyday for hrs but since i am on insulin i am fighting a losing battle.at one point i had lost 80lbs only to regain it all back.the weight started piling on once i went on the second insulin.will i get rejected due my good control of my diabetes.

Answer
Whether you have diabetes under control or not, you still have diabetes. That is still a significant comorbidity. Your cholesterol and high blood pressure are also good comorbidities to have for surgery.

The only "iffy" part is that your bmi is not particularly high...but luckily (or unluckily) you have significant health issues that impact you enough to qualify you.  

My guess is that it will all come down on how your doctor fills on the form. He or she must check at least one box for sure on page 2, (two would be MUCH better). Depending on your doctor's response to the questions of tissue damage or death, OHIP will make one of two decisions:

a) You qualify for surgery but you are not in a life threatening situation so they will say for you to apply for surgery in Toronto, Hamilton, Ottawa or Guelph.

OR:

b) Because of your significant comorbidities, you need surgery right away so they will approve you for Michigan.

I would suggest that you really "encourage" your doctor to check off the boxes and plead the urgency of your case.  That will make all the difference with your lower bmi.

Have you checked out your local support group?

Dawn