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Out of Country
- Prior-Approval Application Process
... for residents of Ontario who
can't wait 6-7 years to have WLS in Ontario
April 28, 2006 update:
Given the volume of Canadians from
Ontario who have found this website and emailed me with questions
or requests for help with the Prior-Approval for Out of Country
coverage process, I have created this new page which makes
available template documents to assist individuals with the
process.
__________________________________________________________________
The prior-approval application for out of country (OOC) coverage
is available for download from the Ministry website in PDF format.
It is also available
at this link
for your benefit. Make sure that somewhere on the application you
detail your weight, height, and BMI. The MOH-LTC (Ministry of
Health - Long Term Care) people want to see this right on the
application and not just in your cover letter.
Getting approval depends on your co-morbidities (eg diabetes, high
blood pressure, sleep apnea etc) , your BMI (body mass index), and
in part, how your family doctor completes the form. Those that
have been more successful have filled it out themselves and then
had their doctors review it and sign it. However, the Ministry's
expectations are that the family doctor completes the application
and signs it. Please discuss this with your doctor.
The key issue in the application or more aptly, the approval
process, is if the extremely LONG (6-7 years) waiting list for
surgery in Ontario will put your life at risk for death and/or
permanent tissue damage. You need to have a frank
conversation with your family doctor about these two factors.
Hopefully you have a supportive family physician. I did not and
had to do all of my own research and then sell my doctor on why
the duodenal switch was the only procedure that I would consider
and how I was unprepared to settle for anything less.
How it works is that generally MOH-LTC receives the application
and then an MOH-LTC team reviews applications twice a month. In
less than 4 weeks they generally respond to the family doctor with
a copy to the surgeon by fax (and sometimes a letter to the
applicant via courier). If the applicant is approved, unless the
applicant has already had a consultation with the surgeon, then
MOH-LTC approves the consult (not the surgery) at this point.
Then the applicant has his/her consultation with the surgeon
(expenses for the consult - meals, travel, accommodation are your
responsibility as the Ministry only pays for the consultation
fee).
If the surgeon deems the applicant a good candidate for the
procedure, he/she will communicate same to the Ministry. The
Ministry then will send all parties a follow up letter advising
approval for the procedure.
What you can do to help your case along... Include with your
application for OOC approval:
-
a cover letter less than 2
pages outlining why you need this procedure, the impact of being
morbidly obese on your health and well being, on you ability to
continue with gainful employment, the impact on your quality of
life and family / social relations -- etc. This is where you get
to sell them on how this procedure will actually benefit all
because you will be less of a drain on our health care system
given that the surgery will correct a lot of your co-morbidities
etc. It works best if you enter your co-morbidities in bullet
format rather than in paragraph format. List them all including if
you have difficulty wiping after bowel movements. Some brave
applicants even include pictures of themselves in their underwear
-- different angles: front, side and rear.
-
any supporting documentation
you can collect from GP and consultations with other medical
professionals to back-up and demonstrate the existence and
severity of your co-morbidities. Letters from any of these folks
supporting your decision to have bariatric surgery would be useful
if they can add that the outcome of the surgery would be critical
or have an enormous impact on improvement to your health and well
being.
-
a history of your previous weight
loss attempts and outcomes (if you've lost weight and then
regained more than you lost, repeatedly, then a chart outlining
this history will demonstrate that trend, if this applies to you.)
Here is a list of documents that I have uploaded to my WLS website
that you may find useful as template documents ...
Blank Out of Country
Prior-Approval Application
http://dawn.thot.net/wls/templates/OOC_Application_1442-84_.pdf
(PDF file requires Adobe Acrobat Reader)
Template of the OOC application to assist you and your
doctor in completing the application (it includes the bariatric
surgery code -- 278)
http://dawn.thot.net/wls/templates/Barb_template_OHIP_OCC.pdf
(PDF file requires Adobe Acrobat Reader)
Copy of my 10 year diet history and outcomes document
http://dawn.thot.net/wls/templates/10_year-diet-history (Word document)
Template document you can use to create your Cover Letter to
accompany your OOC application for prior-approval.
http://dawn.thot.net/wls/templates/OCC_Cover_Letter_template
(Word document)
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