Northern Ont. woman wins fight to have OHIP pay for surgery to remove excess skin

A review board has ruled that Ontario’s health system should pay for surgery to remove a ring of excess fat and skin a northern Ontario woman was left with following weight loss surgery.

Known as a "pannus," it extends as far as three inches around her waist and causes the woman skin irritation, infections, odour and back pain, said the transcript of the Health Services Appeal and Review Board hearing.

After her gastric bypass surgery, the woman’s weight dropped from 248 pounds to 148 and has been stable for more than a year.

Her plastic surgeon submitted an invoice to the province seeking payment for the surgery, but it was rejected.

OHIP said there are three requirements to have the surgery funded: the pannus must be causing health problems, the patient’s weight must be stable for at least six months and the pannus has to extend to the "pubis symphysis," a joint sandwiched between your left pelvic bone and your right pelvic bone.

"The pannus does not extend to a level below the pubis symphysis," OHIP said, in turning down the request.

In her appeal, the woman argued that she needed the surgery not for cosmetic reasons, but for real medical concerns.

"The appellant believes that eligibility for a panniculectomy should not be based on measurement criteria alone, but rather based on medical need, which she believes she meets," the transcript said.

While not ruling on that argument, the board accepted more recent measurements of the woman’s pannus, which found it did extend below her pubis symphysis, making it an eligible surgery under OHIP rules.

"The appeal board finds that the proposed panniculectomy is an insured service … and is eligible for payment," the board ruled.