u/EmZee2022

M0y (66, BRCA1) mastectomy and DIEP flap is tomorrow morning.

The plastic surgeon's office did not submit the prior auth until I had reminded them. Twice. They finally did it 4/29. Approved immediately.

I looked - and they did it WRONG. DIEP is not outpatient. Good thing I looked!!!!!!

I called and they resubmitted it quickly, 5/1. And it was still showing as pending as late as this morning, and nobody from the PS office was responding to let me know that they'd been in touch with insurance to get it expedited.

I somehow got routes to the breast surgeon 's scheduler. She called and said it was approved. I checked and the one she cited was the old, wrong one. So I got excited too soon.

I finally got the correct person, and she's going to call insurance..We'll see..

FMLA gives you up to 12 weeks a year of job protection (I'm ignoring nuances of things like time at the job and employer size and so on for this question).

But many jobs have short term disability that goes far longer than that, and long term disability coverage that can last for years.

What happens if you use up all your FMLA entitlement, but you still have time left on your disability? Can the company decide to let you go while you're on disability, and basically boot you with no benefit? If so, what's the point of offering plans that are longer than their mandated FMLA limits?

Or must they leave you on the disability insurance coverage until you are medically cleared, THEN boot you?

I don't know if that varies by state also - I know some states have better protection than others (mine is not one).

Which will be my twelfth and last with this gastro: he's about my age (65+) and I'll be on Medicare by next year, and in my state Medicare won't pay for it in these standalone clinics (even though this one is JCO certified).

So I'll have to do the next one aftet that at the hospital - much less efficient, and with a different doctor, who may try to argue for a different prep than my trusty Clenpiq. Oh HELL NO.

Doc was fine with my prep. He didn't recall offhand which I used as he didn't have my file open. "Suprep?" . I quickly assured him that no, I needed Clenpiq because of how Sutab hit me. He had mercifully forgotten, LOL. I said "They had to change my gown mid procedure!!". Then he remembered, and agreed!

I asked about whether a hysterectomy causes issues with a colonoscopy - he topic has come up either here or on the hysterectomy subreddit. He said that of course there will be some inner abdominal scarring and adhesions, but that this should pose no issues for a competent doctor. I guess I'll find out in September. The one thing I can see it affecting is: since my hysterectomy,y chronic diarrhea has improved. Not cured - I still need my Welchol - but I won't have as much of a built-in boost to the prep, LOL.

The most amusing bit was that in my instructions, orange is no longer on the list of prohibited colors. Dunno if that's an error; I'll likely reach out to confirm. But it would be nice to have some more beverage and Jello options. Red, blue and purple are still forbidden.

Notes from a recent pulmo visit, preparatory to a lengthy surgery in less than a w(eek!!).

" would also suggest appropriate mitigating measures for adalalasis prevention as well as pneumonia prevention, to include but not limited to: early extubation, mobilization and incentive spirometry"

Nothing sounded unfamiliar except for the term "adalalasis", which I've never heard before. Googling it got me nothing. The notes were transcribed using voice to text, so I assume that was a mistranslation - any ideas what it might have meant?

Also: I know I'm going to be given an incentive spirometer. I think of spirometry as the thing where you blow out as hard as you can. But is an incentive spirometer exhaling or inhaling? If it's inhaling, is that uncomfortable? Aside from the normal pain I'll be experiencing after the surgery of course.

Hopefully the link works - seems to be valid for guest access:

The Conundrum of Exercise for Weight Management in the GLP-1 Receptor Agonist Era | Lifestyle Behaviors | JAMA | JAMA Network

No surprises, exercise is beneficial 😄

Inspired by a posting on another board. I've got an OOP max of x dollars for in-network, and x + 2000 dollars for OON. I think the deductible is the same for OON versus IN.

From an experience a couple years back, where a service was incorrectly processed as OON, insurance paid a LOT less than for the same service as in-network (450 versus about 800). And the facility wanted the balance (over 2300) from me. When it got reprocessed, insurance paid a few hundred dollars more - a total of about 800, and I owed nothing else.

1. Is it truly typical that their "allowed rates" are routinely that much lower for an OON service than for an IN service? You'd think they'd treat the two as the same - this is REALLY punitive. (assumed answer: yep.)
2. What figures would count toward the deductible? The artifically lowered OON rate, or the amount that would have been allowed if it were in-network? (assumed answer: the lower rate)
3. And the OOP limit: same question.
4. Do you still owe that massive overage if you've hit the OOP out of pocket limit? (assumed answer, yes).

This will of course vary by plan, I'm just curious to see how it plays (pays!) out for others.

I've been fortunate that I'm in an area where pretty much everyone is in network - though that one procedure gave me a scare as if they had truly been OON, I'd have had to go through a different hospital system, one that I despise, for some very necessary and $$$ care.