OHIP -- Fat Grafting delisted

Mantra · October 2012

I didn't realize fat grafting was now delisted. I'm booked for surgery and it's upsetting enough to have gone through cancer, double mastectomy and everything else, only to find they won't pay to have the fat grafing I need to finally be finished. Sucks. Very disappointing. Anyone else going through this?

rozem · October 2012

seriously? a friend of mine is having this done next month

so its not covered? why????

Mantra · October 2012

Fat grafting was delisted as of September 1. Is your friend paying? My surgery is a Princess M but it's still not covered

pip57 · October 2012

There has been some reports that put the practice in question.

rozem · October 2012

mantra - if she is paying she is certainly not aware of it. Her surgeon is at womens college. I will ask her to inquire and get back to you

Mantra · October 2012

Thanks. I'd really appreciate it. I'm paying $1260 + HST for fat grafting on one side. I am also paying $865 for nipple fat grafting on both sides. They have submitted a request to OHIP to see if they will cover the cost of the nipples but regardless, I definitely have to pay the $1260.

Mantra · October 2012

Hi Rozem, Did you ever hear back from your friend regarding the fat grafting?

mouse62 · December 2012

Just found this out in a letter from ohip. I was going to get this surgery for cancer breast reapir. they took a third off and i am now lopsided. I am fighting it. Please reply to me i am trying to get some women together to fight this. It's not right. They say it's cosmetic surgery. No its not they are replacing the cancerous sectionthat they removed. When men have testicular cancer they replace it with a blank one. You cant see that through your pants. But whenever i put a shirt on you can tell im lopsided. Very pshycologiaclly disturbing and depressing. me. Anyone else dealing with this delisted issue. Please contact me. Together we can be one stong voice. thanks

(Edited by Mods to remove member's personal email address, for her own privacy and security.)

mouse62 · December 2012

Mantra write your member of parliament and tell them about it. I have just written mine today and im waiting. I am also appealing their decision and trying to get it grandfathered. If there is a will there is a way. Stay strong together us women can fight this. It is a matter or principle. I'm sure whoever signed my opaper the adjudicater ( and you wanna bet he was a man) has no clue about what it is like to survive breast cancer mentally or pahysicallyl. Shame on the person who said no i hope they never have to deal with this disease.I waited a year to make sure the cnacer didnt comeback and i had cancer in 2011. they just delisted it in september but the government also said they had other options to replace that were covered. Please investigate before you pay anything. Good luck and keep us posted.

rozem · December 2012

sorry forgot to reply to this

the fat grafting my friend is having done is a new procedure where they inject fat and try to grow stem cells to create a sling/support for an implant on radiated patients. Normally they would have to have a flap procedure. I know this is covered but it is very new. Not the same as fat grafting to fill in areas after a lump or msx reconstruction. My doctor at TG thinks its quackery -but i know its being done in the US all the time

yes this sucks bigtime that it is considered cosmetic - I am going to ask my PS next time i see him

Mantra · December 2012

I wrote OHIP and got a letter back saying they never covered fat grafting for breast reconstruction and therefore it has not be delisted. Interesting since I did have fat grafting before and it was paid for. It goes on to say that their is no provision under the Health Insurance Act enabling the general manager of ohip to exercise discretion to extend services not prescribed as insuranced services. So I really don't understand what was delisted and what used to be covered. I do know that when I booked the surgery (which was identical surgery to the previous one), the secretary told me that this time it would not be covered because it was delisted.

mouse62 · February 2013

I did it . I appealed the refusal of fat augmentation and they set an appeal hearing for this may 2013. While waiting OHIP reversed there decision stating the following:

"The Ministry of Health and Long-Term Care has conlcuded that breast reconstruction/lumpectomy (code R152) does not require the Ministry's prior approval." THIS IS A VICTORY FOR THE WOMEN. sPEAK TO YOUR SURGEONS AND QUOTE THIS NUMBER r152. It was in my letter and i found it on the Ministry of Health website under payment schedule for surgeons. Oh Ya good luck to all. I see him in two weeks to set up my surgery to replace the partial removal of my right breast.

There is hope if you fight.

Signed cancer survivor who is taking a stress break after a long paper trail of three months of fighting with goervment. It was worht it if it helps the next person.

Mouse62 will let u know when surgery is scheduled.

Mantra · April 2013

Thanks for the info. I sent an email to my Doctor's office and included a copy of your post regarding how OHIP decided to cover your surgery. Hopefully I'll receive some good news too!

Enerva · October 2013

Hi, i saw my PS this past week and she told me she plan to do FG on my rad breast. I had not clue even what she was talking about. Can you ladies tell me if your issue got resolved ? I have no money to pay for anything at this time, i am just getting by now after all. Please let me know, thanks

Mantra · October 2013

The procedure is now covered by OHIP. Unfortunately it wasn't covered when I had it done and OHIP will not reimburse me for the $2400 I paid. I think the success of the procedure is really dependent on the doctor's ability. Over the years I had the same spot done 3 times (first two times covered by OHIP). Is there an improvement? Yes. Is there still room for improvement? Yes.

What they do is transfer fat from another part of your body (stomach in my case) and inject that fat into the breast to fill in dents. It's a pretty painless procedure.

Enerva · October 2013

Thanks Mantra, i have a problem with tightness on the radiated breast and the ps said this fg ll help prevent it from happening again after the exchange but i have no clue. Thanks for the update

barbe1958 · November 2013

Fat grafting is not very successful unless done DROP by DROP. When they just suck up fat from one place and inject it in another some fat cells are damaged and eventually collapse (do I see a weight loss surgery in my future?!?!?). That is why it has to be done a number of times to replace the damaged cells. There was a surgeon in Florida that was doing it drop by drop a couple of years ago but his pricing was SO prohibitive!!!

After my double masts I wanted the "fat ridge" (we all have it) removed from below where my breasts used to be. OHIP wouldn't do it. I asked the surgeon if he could us another terminology to get it by them but he said they had to provide pictures of the "after" surgery. I had already had him submit his pictures of my "before" chest, you'd think someone would have taken pity on me!!! I wasn't asking for 2 neurosurgeons to do a DIEP - I was asking for a plastic surgeon to remove a ridge of fat!!

hrf · November 2013

Apparently, fat grafting does work well to fill small area. My PS said she may do some fat grafting on me to fix a small area. OHIP will cover this.

Barbe, you ask a good question. I agree that they should have helped you. OHIP is good but it could definitely be better.

OHIP -- Fat Grafting delisted

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