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

Karik,

Deep down I know you are right, but it is so friggin' hard for me to do that.  And I teach all of the grade levels, thus I have to write the curriculum for all of the grade levels.  Curriculum is written and up on Atlas ready to go, but the next step of adding in specific resources and lessons is there lurking and waiting for me.  I had planned on building that plane while flying it.  I have a gob of ideas/projects/resources accumulated and ready to plug in- but it is too much to try to do before class starts.  Frankly, I need some time off too.  I have been working 50-60 hours a week every week on my "summer vacation" knocking out curriculum, attending PD's, reading a dozen tradebooks, etc.  BUT, this does put me in a position where there truly is not another person in the district who can help out.  I will be teaching technology skills integrated into the curriculum for K-5.  All students in the building will see me for 40 minutes per week.  And of course, my evaluation is tied to the performance.  If my kids don't come out typing a certain number of words per minute, for example, then I can be scored as a minimally effective or ineffective status.  This is a pilot year for the program so it is unclear how the evaluation will work given that the keyboarding example is assumed to be cumulative skill over the years and I am heading into year 1.  

But you are right.  The school will not fall apart for the few weeks I would be out.  But uggghh!!!!!!  And heaven forbid I have to go out on a medical for the cancer issues- a constant concern given for the last couple years I have had at least 2 periods a year where I had to go out on medical (both under 10 days each, but still...)  

Oh and CONGRATS!!!!

call your insurance. if they already approved it under the old guidelines then the case is already open with them so the new changes shouldn't apply. at least that's now it is with my insurance. 

Good point.  Maybe I read too much into the letter and they were referencing switching carriers or something.  It is worth clarifying because if the switch doesn't matter than the preauthorization is good for the year... which allows me to make it to the next summer vacation.  The only bad thing though is right now my deductibles for the year are met... after Jan 1 it will set me back $2500.  

Thank you for this suggestion!  I just got off the phone with them and sure enough, the 12 month window still applies.  My provider isn't changing, just the level of deductibles and the name of the plan.  Now the only bummer is that if I do it before October 1st I have no deductibles, but after I get nailed $2500- still a bargain though.  I find out a little more on August 6th about the other potential surgeries coming up, but at least now I don't feel like I have to have surgery tomorrow in order to be able to use the reauthorization. I also found out that if I want to change surgeons I have to restart the entire process... and I was (happily) surprised it was approved this time and don't want to risk undoing that, so I will be dealing with the surgeon with the crappy office staff.   And... it will give me a chance to see the parent that had her surgery done by him this past June to see how it went.  Nice!

Of course, my surgeon still hasn't returned my call grrr....

I'm with Kairk - you should take care of yourself first, in order to better enable you to care for others.  But you have excellent suggestions here for alternatives, too.

Two questions:  1)  Does your state/district offer a 'medical sabbatical' or 'extended sick leave?' You may be able to take an entire semester (or even year) at reduced pay in order to address all of your medical needs, not just the WLS ones.

2)  Can this new program be piloted in the second semester, instead of the first? (As it seems like you will be acting more as an 'ancillary' teacher, even though you are impacting the entire curriculum.)  I know, it messes up the evaluation cycle............but there ARE exceptions to every rule.  And taking off the first semester would allow you to flesh out your program, too.

Congratulations on that approval, and best of luck with your decisions!

Good questions...

A medical sabbatical is out of the question.  The mastectomy and ovary surgeries are preventative procedures, so I can schedule those around my breaks so long as my cancer status continues to behave.  The more they know about me going into surgery the harder it makes it at work- exponentially so.  

The program starts in the Fall.  I am working a "special"- so it is like a gym teacher or music teacher situation.  It can't start in the second semester consequently.  This is why I have to write curriculum across all of the grade levels and have over 800 students.  

Now if I can just get the friggin' surgeons office to return a call!  I think I am going to call my insurance to see if the preauthorization works for any plastic surgeon.  If I can avoid this crappy ass office staff I am going to!!

Congrats! Can you share insights on what you did to get it approved?

First, I called my insurance to see if they ever approve any part of plastic surgery.  The person I spoke with truly tried to keep it vague, so you have to call knowing what to ask for.  Take the codes from my OP and use those- they are standardized for the industry (or at least I am pretty sure they are).  Ask them specifically about these codes, and what is required for preauthorization.  So, for example- my insurance requires that you are a bariatric patient who has lost a minimum of 100 pounds, that the pannis hangs below the pubic bone, or you have skin issues that are documented for failed interventions.  In other words, if you are having ANY skin issues every time you go to the doctor discuss, document it, get prescription creams for rashes or what have you versus using over the counter.  

Next, I attended one of the plastic surgery seminars offered in my support group.  This gave me background info and a chance to ask questions.  I did that before surgery though and so I couldn't ask all the questions that are relevant because I didn't know what to ask.  

Finally, as luck would have it I was at work and a parent of one of my former students approached me about my weight loss.  She had the DS surgery and wanted to know what I had.  (Only person who directly asked me this by the way- I do not reveal at work.)  We started chatting about the lose skin of hers,  and she mentioned she was about to go in for this.  I asked her about insurance and she got hers covered.  She commented that it is much easier to get approved with Blue Cross and she knew this is what teachers have here (called Messa if you are a local).  Anyway, she then explained that she had a friend *****ferred her to this doctor because he does an outstanding job of securing preauthorizations and works a lot with bariatric patients  So, I don't know what this guy does differently than other surgeons in the area- but he totally got a stellar preauthorization for me.  If only his office staff didn't suck so bad!  

I have absolutely no idea though if my skin cancer status has anything to do with my getting approved.  In my mind at least, the more skin I have the greater the risk so it just plain makes sense.  But it could have nothing to do with it.  

I so wish I could go into surgery tomorrow!!  I would be healed enough to start the school year!

Happy teacher, I wish I could help more, but still so new at all of this. My best friend went to Dr Aviles for breast implants and absolutely loved his work. Wants to go back to him when they need redone.