Summary of the Case

The Appellant, who suffers from hyperthyroidism, has requested Ontario Health Insurance Plan (OHIP) payment for a proposed panniculectomy surgery following his bariatric surgery which was performed to achieve significant weight loss. The OHIP (Respondent) has denied his request for funding of the procedure. The Respondent takes the position that the surgery does not meet the requirements for funding in Appendix D of the Schedule of Benefits. The issue on this appeal is whether the proposed panniculectomy is an insured service of OHIP under Appendix D for which funding should be granted.

Mooters should consider the following questions:

  • What does it mean for symptoms to be ‘significant’? What is the key difference between elective and medically necessary surgeries?

  • At what point does discomfort become medically significant?

Please refer to the Participant Package for more information on the case, and the conference as a whole.