Rejected for coverage (Canada)

[Patsfan1991]

Got rejected for coverage, can anyone walk me through what they did in Canada to get covered by provincial healthcare?

[srnd2012]

I saw my family doctor first and then was forwarded to an Endo.  Met with the Endo and took some tests to see where my levels were at.  The Endo sent my file to the PS and after my first consultation he sent a recorded audiotape and pictures to Medicare and about 1.5 months later I found out the surgery is covered 100% for excision, and I'm dropping about a grand on lipo.  I want it done right the first time. 

What I've done requires a lot of patience for sure,  as I am still without an appt date.  I'm from the province of New Brunswick and there aren't a great selection of PS who specialize in gyne surgery.  I sought out the best and he has a long list of patients.   One thing I've noticed from reading these boards is that many others have an apt like a month or 2 after a first consultation.  I wish that was my case but I really can't complain.  My PS has an excellent reputation, performed many of these surgeries and seemed to know a great deal about it.  And on top of that it was covered by Medicare.
It's unlikely that I will have my surgery until the fall now   I wanted to be ready for this summer,  but on a good note it will be easier to hide my compression garment in the colder months and I can heal up during next winter. 

That's my experience thus far.    Best of luck!

[Patsfan1991]

I got referred by family doctor to a PS, and the PS wrote a letter to try to get it covered and they just flat out rejected it. I could understand the rejecting for lipo, but the excision as well? It's pretty harsh and my PS gave me an estimate of 8k, which I think is kind've crazy, because I fall within the average category of gyne. Considering appealing the decision, I have a follow up with both my family doctor and my PS. The thing that I want covered is the excision, as I can lose the extra weight. Thanks for the info and sorry for venting, they called me today and dropped the bomb on me that it was in no way covered. Seems like they just rubber stamped it.

[srnd2012]

Sorry to hear that and best of luck.  Which province are you from? 

Also you should post some photos (if you haven't already).  I started a thread back in September with photos,  since then I've been on TRT and I've lost 15 lbs.  Figured the better shape I was in before surgery,  the better result in the end. 

[McGilli]

I'm in B.C.

Doctor referred me to PS.

I had to pay $5500 - the rest was covered by Government. The gland was covered for removal. But of course - I wanted lots more removed to make my chest flat.

I only had incision done.

Since the government paid for some of the surgery - I did not have to pay and HST on my portion.

There was no waiting - I was presented with the quote 5 minutes after my initial consultation.

I was expecting to have to pay for it all - I was happy to not have to pay any tax on my portion.

[Patsfan1991]

I think what happened is they didn't at all take in to consideration the psychological aspect. I am going to speak to a psychologist and have them write a letter for me during the appeal process. I think the worst part of this affliction is that we have psychological trauma that doesn't allow us to interact with society in a nornal way.

[jazzer]

Hi. I live in Alberta and received 100% coverage. My plastic surgeon knew of my emotional stress, and opted for a double mastectomy with free nipple graft. My sacrifice is pretty horrendous scarring but I never go out with my shirt off. So I paid a hefty price that way, but it was very very worth it.