Abdominoplasty with panniculectomy approved!! Questions to those who are smarter than...

Hello,

I know there is a plastics forum, and I will cross post there.  Please be patient.  I like this forum, I feel like I know the folks here (or at least their online personas) so it is easier to digest responses.

My preauthorization from my insurance just came and I am approved for "abdominoplasty with panniculectomy (CPT 15830, 15847)"  

I am not sure how much this covers in what is commonly referred to as a "tummy tuck".  Does this mean the get rid of the pannis AND do the long vertical cut up the stomach and get rid of the extra stomach skin or is it just referring to the procedures required to remove the pannis?

If I have the skin on the neck removed and face lift at the same time I get that I would be responsible for the extra surgeon and anesthesioligist fees.  But what about the recovery portion in the hospital?  Would I have to do some type of prorated pay for that as well?  

Finally, a what would you do if you were me question...

My insurance changes as of January 1st and thus will null and void this authorization letter.  School starts by contract August 28th.  I doubt I can get into surgery in the next week or so, which would allow me to make it back for the first contract day.  If I am not there for the first 2 days it totally mucks everything up so that is not an option (something about the insurance for our district- a teacher just found out that she has to attend the first 2 days and THEN have her surgery thus forcing her to miss 8 weeks of when the students are there... makes no sense to me at all).  So, if I have surgery it will cause me having to take a medical leave.  This STRESSES me out to no end, and I hate what happens to my classroom when I am gone.  On top of that, I am responsible for starting a brand new program this year and there is literally nobody in the district a sub could go to for support since I have spent the summer writing the curriculum for  the 6 different grades and 800+ students I will be teaching.  Oh, and it is all technology based so the sub situation would be dire- nobody skilled enough to deal with the tech let alone handle the work load of the new curriculum.  But, I have everything set up in the cloud so I can manage some things from home... but I digress.  Do I risk it and assume that my new insurance (same company, same coverage, high deductables is the biggest difference- but brand new policy numbers and such so it is considered a change in the insurance) or deal with the medical leave?  For those that don't know me here... I am also a cancer patient (under control and in great shape) and my staff will just assume that I am once again preparing to die and I have a bosshole with some serious discrimination issues.  Ugh.  So much to think about!  So go for it, or pray it will be approved a second time later down the road?  

Ok. lots of questions.  I am hopeful there is somebody smarter than me out there that may have some insight.  Thanks in advance!

Hi

I have no idea about the other stuff, but could you do your surgery on Christmas break?  Just a thought.  Hope it will work out for you with the insurance.

I am not sure about that... technically January 1st is that new insurance, so I am concerned that anything that occurs after the 1st may not be covered as a result.  The surgery technically could occur December 15th or so without it mucking up my classroom to much- but the follow-up care may be a problem.   Also, it is looking like a double mastectomy and an additional surgery to get rid of the ovaries and such is in my future- that would likely occur over the Christmas break for one of them. 

Hi. I am sorry I can't help with your questions but I have one for you. Who are you using for your plastics. I am in the same area and have met with dr. Aviles who I like a lot. I am just curious who else is in the area doing post wls plastics well. Good luck to you!

DiNick- I have some real mixed feelings about him.  His pics of his work are outstanding, bedside manner good.  Office staff (making appointments, returning calls, etc. is HORRIBLE.  Reviews on this site for him are less than stellar for some, great for others.  I went to him recommended from someone I know at work who heard he is particularly skilled at getting insurance approval for procedures.  Thus, I went to him because I can't afford it on my own and can deal with a crappy office staff if it means insurance covers the procedure.  

Sounds like you were approved for the full tummy tuck with muscle repair.  The panni covers the belly button down, skin removal only.  The abdominoplasty covers the rest.  Actually, I think it's overkill, because the abdominoplasty covers all of it!  But better to have more approved than less.

Timing - start the school year, get your program up and running, and schedule your surgery in November to take advantage of the Thanksgiving break.  There's never a perfect time to do it, so just do the best you can.

Didn't think about that Thanksgiving break- that would help a little.  Great suggestion- thank you!

Dont forget...if getting the whole abdominalplasty done and not just the panis, the recovery time for this will be at least 6-8 weeks.  Because it involves the muscle too and not just removal of the skin.  So no heavy lifting....some docs wont allow driving until a 2 week followup and of course not while on pain meds.  You will probably be VERY slow in moving.  Not sure if you have had any other abdominal surgeries before, but I can pretty much guarantee you, it doesnt feel like our sleeve/lap/rny surgeries.  This is a little more indepth.  Hope this helps.

Best of luck.  Christmas Break may be better than thanksgiving becuause usually you at least have off like 3 weeks....

Ok, I will be sure to check on the recovery time needed.  Thanks for the heads- up!

Of course, I don't know your district, work conditions, union support, etc..... but I vote for the medical leave. Districts/principals tend to take advantage of the care giver instinct of teachers to a fault. Clearly, if you've been writing curriculum for more than your own classroom you are working far beyond the scope of your contract - unless you're a TSA. I have taught 20+ years and the one thing that I have learned is that not one of us is truly indispensable. We'd like believe we are, I know, but there is always someone waiting in the wings that can come in and take over - maybe not the way we'd like, but they do it their way. And in the big picture it will be just a few weeks out of a child's educational career - not life changing.

My opinion is that you need to do what is best for you. If that involves taking a leave this fall, so be it. You have no idea what your insurance will approve next year. Take advantage of this gift while it's available.