WHY am I leaving the US for surgery? And why the choice I made?

[Kristopia 0]

Why am I leaving the US for Surgery? Here are my reasons:

1. My United Health Care insurance refuses to pay for ANY type of WLS surgery - they won't even pay for a doctor supervised weight loss program, period. Ridiculous.

2. I live in "medicine city" - Durham, NC. We have Duke Medical Center, not to mention huge amounts of other hospitals, specialists, pharmaceutical companies, labs, etc. Even so, I found two surgeons that were even slightly experienced in VSG - I was going to get RNY (because to me, a tool is a tool, except I didn't want a lapband, for all the reasons cited on this board), because insurance would never cover VSG - not this insurance in this state.

3. I saw my surgeon twice - once back in January at the seminar, and once at an initial consultation for 10 minutes. He was nice - but damn, 10 minutes? His office staff were coldly polite, and the insurance girl was a pain in the butt - she never called me back when she said she would, and she told my my insurance would cover - I jumped through ALL the hoops, and got ALL the pre-surgical testing. All of it. I have spent well over $1000 out of pocket for all of the pre-surgical testing. More to come, I'm sure, as I'm not done getting all the bills yet that insurance wants me to copay, etc. In the end, nothing.

4. My surgeon, while experienced with RNY and lapband, has only done about 30 VSG surgeries. And even with RNY and lapband, he doesn't measure up to the experience my chosen Mexican surgeon has....OR his track record.

5. In the US, my surgery would cost a total of $35,000, including surgeon's fees and hospital fees (that's only two nights in hospital) if I pay out of pocket. Seriously?? Yep, seriously.

So, I researched surgeons in Mexico, and researched, and researched, and I've chosen my surgeon. I've chosen Dr. Armando Joya in Puerto Vallarta, Mexico. I know Dr. Asceves seems to be the popular choice here, and I'm certain he's a great surgeon (they were both tied until recently), but here are the reasons I have chosen Dr. Joya for myself (and we all must make a personal choice of surgeon we are most comfortable with).

1. Dr. Joya has well over 500 VSG surgeries under his belt, as well as thousands of other surgeries including metabolic, etc. He is a gastroenterologist, which I'm glad about. He seems to me to run pretty much even with Dr. Aceves. So it came down to cost and location, really.

2. Covered in that cost is three nights in the resort, two nights in hospital, cabs, yadda yadda yadda. Everything but flight - and complication insurance. It's a little higher than Aceves, but I'm willing to pay the extra for my comfort level.

3. Private small lovely hospital.

4. Flight goes straight in to Puerto Vallarta airport, where you are met with a sign with your name on it, then transported to the resort, which is only 10 minutes away from the airport. You are met by Natalie, Dr. Joya's coordinator/assistant. The hospital is from 5 to 10 minutes from the hotel. All of the transport is taken care of (though I'll carry money for tips for the drivers).

5. After surgery, like Dr. Aceves, there are leak tests performed.

6. I will not have any drives over borders or for longer periods after surgery - I'll have the very short drive to the Puerto Vallarta airport, and then a 20 minute trip from my airport here in NC to my apartment. The flight itself, with one stop in either Dallas or Houston, is in two sections, both under 2 1/2 hours. The layover is short, so enough time to walk a bit in the stopover spot, but not enough time to be uncomfortable or overtired.

7. the location. I have always gone to the ocean to heal, whether it be emotional healing or physical. there is just something about Water that I need. And, a very close friend is going with me - we decided also that since both doctors were equal in my estimation, it was worth a little extra to go to Puerto Vallarta, which is beautiful. I'll spend two days extra vacationing (except for food, I'll be stuck with clear juices and broths and water) before surgery, and a couple extra after I leave the hospital as well.

8. Dr. Joya actually comes to visit his patients in the resort. Can't get that in the United States :thumbup: I seriously doubt the surgeon here would make house calls.

I believe I have made the best choice for me and my comfort level. Several docs in Mexico are highly reputable, but Dr. Joya is my choice for the reasons above and many others, but this e-mail is too long already

I'm going to send my deposit within the next few days (either tomorrow or Monday), and hopefully will get my passport soon so I can schedule the surgery for end of July or early August.

[Ruthi 60]

Congrats, I am sure you will be happy with your decision

[MacMadame 81]

$35,000 for a sleeve is crazy, even in the US. I only paid $17000 and I live in one of the most expensive areas of the country!

This is something that has always bugged me about bariatric surgery -- the wide difference in prices and how you don't always get what you pay for.

[Malaika 50]

$35,000 for a sleeve is crazy, even in the US. I only paid $17000 and I live in one of the most expensive areas of the country!

This is something that has always bugged me about bariatric surgery -- the wide difference in prices and how you don't always get what you pay for.

The surgeon I originally thought I was going to use before doing more research and talking to WASa was charging $25,000 for the sleeve and that was HIS fee only. It is ridiculous the span of prices from state to state.

[Elisabethsew 50]

Congratulations on deciding on the right surgery and surgeon for you.

[Kristopia 0]

Yes, it IS ridiculous - the variations AND costs - one reason I'm definitely supportive of regulating our health care industry. My U.S. surgeon's fee alone would have been $12,500 - without hospital fees. I have a very close friend that got her VSG last July - same surgeon, same hospital I would have used - $36,000 total. That's for two nights in hospital and the surgery. It is horrific that they'd charge that much for two days, but there you have it.

Even if my insurance HAD covered at 70% (which is what the surgeon's office told me), that would still be over $10,000 out of my pocket in the end. More than it is costing me to go to Puerto Vallarta and have it.

Craziness!

[Kristopia 0]

Thanks Ruthi and Elizabeth - it's been a long battle, and has caused a lot of stress and some depression, all the fighting for the surgery - but now I have something to get excited about! :lol0:

[Jaffa 5]

I don't think it is really a coincidence that you can self pay and it cost about the same as with Insurance and your deductible. They know what they are doing, and how to get you to not use the Insurance.

I don't know about the public health system idea, to fix this kind of thing. It seems that a lot of public health systems are so slow that people are paying themselves anyway.

[MacMadame 81]

Wow, those prices are crazy. My guy is the #1 sleeve guy in the US (done over 1200 of them, really low complication rates) and he's charging much less.

But the interesting thing is that they charge a program fee to people with insurance. The insurance companies just don't reimburse enough for the surgeons and hospitals to really cover their costs. So someone with insurance can be paying them as much as $8000 over and above their deductible/copay. Some people think THAT is outrageous.

I used to until I saw how reasonable their self-pay prices are. Obviously, they aren't trying to gouge us or they'd charge the self-pays that much more. Because clearly, they can and people do it pay it.

Health care in this country is so messed up!

[Kristopia 0]

Steve - well, self-pay here would be lots more than my co-pays. But self-pay in Mexico is 1/3 the cost of self-pay here in the U.S. - at least apparently in my area - and yeah, they do know what they're doing - unfortunately, sometimes it doesn't seem all that ethical.

MacM - yep; it is pretty messed up. To me, just having a little regulation would help immensely.

[WASaBubbleButt 41]

Make extra sure you pay that $500 for the complication fund. His last leak cost a fortune, the person was still leaky after 4 months. Also, there is a person that he lacerated her liver during her sleeve and he wouldn't let her leave the hospital until she paid him $1200.00 for fixing it. He didn't even tell her there was an additional $1200.00 fee until the day she was to go home. He wouldn't accept most forms of payment. Finally her mother called with a credit card so she was able to leave the country.

[Kristopia 0]

I'm paying the $500 for possible complication issues, for sure. Do you have the info on the people who had any issues, so I can talk to them? I heard about the liver, but I had also seen his stats on other sites (including OH) that showed much lower complication rates than my U.S. surgeon.

[WASaBubbleButt 41]

I'm paying the $500 for possible complication issues, for sure. Do you have the info on the people who had any issues, so I can talk to them? I heard about the liver, but I had also seen his stats on other sites (including OH) that showed much lower complication rates than my U.S. surgeon.

I don't really know what his stats are. Each time people have talked to their office they get conflicting information. One person claims he's never had a leak. I know that isn't true because his patients have posted about their leaks. Not that they are blaming the doctor for it, I don't know if they knew why they got a leak. But other times you call the office and they say US people have had 2 leaks. If you don't push and ask about his Mexican patients then they don't offer the info that others from Mexico have had a couple of leaks.

I don't care for Joya. It's not that he's not a good surgeon, he's okay. It's that his business ethics are about as bad as they come. He is not a very honest business person. I want a doctor who has good business ethics AND is a skilled/experienced surgeon. Joya just isn't someone who meets my criteria but that doesn't mean others have the same criteria, they do not and there is nothing wrong with that.

I also do not like the way he pushes bypass. One person went there for a sleeve and mentioned that she was afraid of a leak. He pushed her to get bypass saying that if you get a leak with a sleeve it takes months to resolve. If you get a leak with bypass it is resolved in 4-5 days. That's a load! A leak is a leak. You cannot oversew a bypass staple line but you can with a sleeve staple line. So your risks for bypass leaks could be greater for that reason alone but there are more staple lines with bypass so the risk is greater for that reason. But he makes more money with bypass.

Surgeons need to be honest about everything including procedures, stats, complications, the works. We all know leaks are not always the fault of the doctor, so why lie about it?

One guy (not Joya) had a sleeve death. Instead of coming clean and saying he had a sleeve leak/death he claims the complications were really from a hiatal heria repair. That is a complete lie! The family suing this doctor isn't suing for a screw up on the hernia repair, they are suing because the patient died of a leak that was not resolved in time. The doctor should have had this guy in ICU, he did not. The person died. Would he have lived if he was in ICU? No way of knowing. But if it was so bad he died, shouldn't he have been in ICU? Bottom line, this guy doesn't want people knowing he had a sleeve death so he tells people it was really from the hiatal hernia repair.

This is why I wanted a doctor with ethics as well as skill. Otherwise you really do not know if you are getting the truth or not.

[Jachut 487]

I don't think it is really a coincidence that you can self pay and it cost about the same as with Insurance and your deductible. They know what they are doing, and how to get you to not use the Insurance.

I don't know about the public health system idea, to fix this kind of thing. It seems that a lot of public health systems are so slow that people are paying themselves anyway.

Exactly. What happens here is that our system really is very good in that if you have private health insurance, it covers ANYTHING bar cosmetic surgery. I think you should be able to pay a higher premium to cover cosmetic procedrues the same way you do for top hospital cover vs basic cover with an excess.

Our public system works this way - everyone is covered, its not means tested (except that if you earn over a certain amount and dont have private insurance, you pay extra tax). You get 85% of the scheduled fee for EVERYTHING back from medicare.

So, a privately insured patient goes for surgery. The cost of the specialist visits, the surgery, all the presurgery testing and procedures is all billed through Medicare. The patient pays up front and then claims a refund. Then the private insurance covers all the costs of the hospital stay. And for the priveledge of being insured, you get to choose your surgeon and your hospital and get it done when you like and you get better food too.

So... what most surgeons do is charge well OVER the scheduled fee. so you dont get 85% of the service back, it equates to more like 50%. Its ridiculous how much some of them charge. And then most bariatric surgeons will charge a once off service fee (I paid $3,000 for my band) and then bulk bill all your aftercare which means they only charge the scheduled fee and bill it direct to medicare, no out of pockets ever after for the patient.

If you're a public patient without insurance, you can get almost anything done but for stuff like bariatric surgery, you'd wait an awfully awfully long time - but it would be entirely free

It works out kind of stupid - it cost me about $3,000 or $4,000 per baby in the private system and it would have cost NOTHING in the public. However, I saw the doctor of my choosing, no sitting in public waiting rooms in long queues, my ob delivered my babies and i got a nice week in hospital with good food and wine, lol.

[WASaBubbleButt 41]

It works out kind of stupid - it cost me about $3,000 or $4,000 per baby in the private system and it would have cost NOTHING in the public. However, I saw the doctor of my choosing, no sitting in public waiting rooms in long queues, my ob delivered my babies and i got a nice week in hospital with good food and wine, lol.

How does the quality of medical care compare from public vs. private? Is public still high quality?