Ontario's health system should pay for surgery to remove a ring of excess fat and skin left behind by a woman in northern Ontario following bariatric surgery, a review committee has ruled.
The transcript of the Health Services Appeals and Review Board hearing said it was called “pannus” and stretched three inches around her waist, causing skin irritation, infection, odor and back pain in the woman.
After gastric bypass surgery, the woman's weight dropped from 248 pounds to 148 pounds and remained stable for over a year.
Her plastic surgeon submitted an invoice to the provincial government for payment for the surgery, but it was rejected.
Three criteria need to be met for the procedure, OHIP says: the pannus must be causing a health problem, the patient's weight must be stable for at least six months, and the pannus must extend to the “pubic symphysis,” the joint sandwiched between your left pelvic bone and your pubic symphysis. Right pelvis.
“The pannus did not extend below the level of the pubic symphysis,” OHIP said in denying the request.
In her appeal, the woman argued that she needed surgery not for cosmetic reasons but for genuine medical considerations.
“Appellant contends that eligibility for panniculectomy should not be based solely on measurement criteria, but rather on what she believes she meets as a medical need,” the transcript said.
While not ruling on this argument, the committee accepted the latest measurements of the woman's pannus and found that it did extend below her pubic symphysis, making it an eligible procedure under OHIP rules.
“The Appeal Board found that the proposed panniculectomy was an insured service … and eligible for payment,” the board ruled.
