OHIP funding to go to the States - quicker?

Question
Hi, my doctor recently referred me to the Humber/Etobicoke bariatric program in order to get approved for weight loss surgery.  I am willing to pay to travel to the states and have it more quickly, but I don't know how to go about getting OHIP approval so that the surgery itself will be covered.  I am also nervous about the full gastric bypass surgery - I was thinking the sleeve - because I am nervous about the complications of major surgery and re-routing. I have IBS and I worry about bowel blockages or 'dumping' syndrome which are both associated with Gastric Bypass.  That said, I have GERD and reflux and I've just read here for the first time that the sleeve can sometimes make that worse.  What about the removal of Grehlin?  Does that happen with the bypass as well?  What kind of recovery are we talking?  I am a foster parent and have six kids so I'm nervous about the major surgery as opposed to the sleeve.  Does OHIP cover both, and how do they determine which one is best for me?   
My BMI is 'only' a 36 or 37 I think, and I don't have diabetes or sleep apnea.  Do you think I will get approved?  It seems people have far worse issues than I but as my doctor said, its just a matter of time before those health problems surface.  I do have fibromyalgia and degenerative discs so the extra weight on my small height (5'2) has been very painful.  Sometimes I pass out from the pain and exercise is very difficult, except for swimming.  
I'm trying to decide, should I just go to Mexico in January and get this done because I don't want to wait a year or more.  If I can get to the States to do the surgery instead I'd obviously prefer that, but how long would THAT wait be?  Can you just walk me through the process?  I'd really appreciate it.  Thank you so much.

Answer
Hi Heidi,

You have many questions; some are medically related and I am not qualified to answer them.  It seems as though you have done some research on the two types of procedures you mention, gastric bypass and gastric sleeve, but I can give you some more information that might be helpful to you.

OHIP approves both procedures, but will not approve of gastric banding.  Both procedures cause weight loss by restriction and malabsorption, however, gastric sleeve patients usually have fewer problems related to malnutrition and dumping.  In the experience of Synergy Bariatrics in Buffalo, NY, weight loss from each of these procedures seems to be the same and patients are very successful.

To my understanding, OHIP will approve applications submitted by regional assessment centres.  The pre-operative application process involves multiple visits and compliance with a medically supervised program that is six months or longer.  OHIP triages applications according to their parameters of accessibility and medical necessity.  Patients with a BMI of 40 or greater are considered to be morbidly obese and may qualify for surgery, however, it is possible that a patient with a BMI of 35 or greater with obesity related illnesses would be approved.

Although Synergy Bariatrics is an Approved Bariatric Surgery provider, we have had few notifications of OHIP approval for Ontario residents.  Some Ontarioans and even those in NY with no bariatric surgery covered have elected to proceed through the surgical pathway and pay cash if they are an appropriate surgical candidate.  Gastric banding is usually a less expensive procedure, but frequency of band visits and thus costs of time, travel and adjustments should be considered.  

I would urge you to continue you research and make it a priority to be cared for by an experienced and successful team of medical professionals.  I cannot advise you on the quality of programs in Mexico or elsewhere, however, consider that in the event of a complication, you would want the best available care.  Check with your doctor to determine who would manage your post-operative follow up care.  

My best to you in the pursuit of better health.

Regards,

Julia Kabakov  

1. Prev:concerns of Gastric Bypass as opposed to the Sleeve, Vitamin retention, etc.
2. Next:laprscopic gastric bypass surgery soon!