Jump to content
×
Are you looking for the BariatricPal Store? Go now!

It's an insurance issue, not Mexico vs. USA



Recommended Posts

Here is my 2 cents on the Dr. Ortiz thread.....

I look at this "situation" as an insurance issue as opposed to a Mexico vs. U.S. doctors issue.

FIRST of all, I will say that I was very, very, very luckily as my insurance company, Humana, covered my surgery....I thank Humana for their wisdom.

Now.....if other insurance companies were as wise, obese individuals with co-morbidites would be able to look for the best doctors IN THE U.S.A. to perform their surgery and PROVIDE AFTERCARE.

Who goes to Mexico for WLS surgery? Those who had to self-pay! If you went to Mexico for your WLS would you have gone to Mexico if your

insurance covered your surgery??!!!

We don't need to argue about Mexico vs. USA, we need to take this energy and fight the insurance companies who do not cover WLS!!!

Just my opinion.....

Share this post


Link to post
Share on other sites

Excellent point, Margo.

Well said.

:clap2: I've often thought the most pressing aspect of the Mexico banding is the inability to get insurance companies here to do actually cover this much needed surgery for their members. To me a secondary aspect is the rising cost of health care (even at cash pay prices) here in this country.

Of my friends who went to Mexico, all of them did so after being denied by their insurance companies. And all of them have said they would have preferred to have the surgery closer to home, had it been more affordable.

One pal said even though she had to pay cash, she wish she could have had her surgery locally or even just closer like her mother did - but the USA cash prices were just unaffordable.

I've watched the cash prices of Weight Loss Surgery (WLS) and particularly LapBanding come down in the last few years. As more doctors are trained and as the techniques get more refined perhaps the prices will continue to decrease some (without sacrificing quality, and yes I hope that's possible) and make it more affordable even for those who pay cash.

Both of those issues show serious failings in our health care system's approach to WLS, in my opinion. It's treated like some elective or experimental extra, when for many of us it's the only real option for permanent weight control. This is something we HAVE to address here.

Share this post


Link to post
Share on other sites

If I had been willing to fight with them for a year or so, no doubt my insurance would have paid. But I have the money and know a couple of people who went to my surgeon a couple of years ago and are doing great and have had no complications so I read everything I could and chose him. They recommended him to me after I mentioned lapband to them, not knowing at the time that they had even had the surgery. I hope that I don't end up regretting my decision but I think I would most likely feel that way no matter where I had surgery. I had not found or read LBT prior to surgery or I may not have gone there though.

I am sure that if the insurance company didn't make it so difficult that I would not have gone to Mexico but they also would have had to be willing to pay for me to travel somewhere else to get surgery because the surgeons around my area have no experience and I personally know two people who have had bad experiences with them here.

Serena

Share this post


Link to post
Share on other sites

Thats some really good points and for the most part i agree with you.

and maybe my wife and i are the "odd man out" but we didnt go to Mexico for those reasons. we actually went because of the doctor. for us it was a close call between the one we chose and one in italy and in sweeden.

however i do agree with you as to that is why mexico is used so much.

maybe things will change now that the overall cost has come down in the usa (at least in the pacific northwest) to be very close to that of the mexican prices.

right now i believe (and could be wrong) that the biggest difference is mexico does not make you do the psych exam or pay for the blood work up.

Share this post


Link to post
Share on other sites

This probabaly doesn't come up a lot because it is probably more the exception than the rule. In my case, I went to Mexico because US doctors wouldn't even talk to me or return my phone calls. I was willing to self-pay here (if for nothing else, the convenience of local aftercare), but I was only 80 pounds overweight. Obese, but not obese enough. This is a US standard, so I suppose the doctors were doing as regulated?

I don't want to get into arguing the merits or value of someone my size having the surgey, because it really is such a personal choice. Or even if Mexico was really one of my only options (the option of gaining weight to lose, for example). I was just glad that foreign shores provided an opportunity for me that was not an option here. And so far so good.

As I said, that may the exception, but I just wanted to share my experience.

Thanks.

Share this post


Link to post
Share on other sites

right now i believe (and could be wrong) that the biggest difference is Mexico does not make you do the psych exam or pay for the blood work up.

My surgeon required the blood work up and the psych visits. I was in the facility for a week prior to surgery and had the blood work and the psych visits. So some do require it. And yet he still was an incompetent boob. OOPS SORRY!!

Share this post


Link to post
Share on other sites

I may have gone to Mexico because insurance wouldn't pay but now, knowing what I know, and having the choice between US and my dr. in Mexico, I still would go with my Mexican dr. I LOVE Dr. de la Garze and I think, even with all the research that I was treated better there than I could have been in Houston. The follow up treatment has been excellent. The only thing that I pay for is my flight. They even put me up in the hospital hotel. He wants me to stay overnight after a fill just to make sure it's not too tight. I am not sure that I would get that kind of care here in Houston.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Eve411

      April Surgery
      Am I the only struggling to get weight down. I started with weight of 297 and now im 280 but seem to not lose more weight. My nutrtionist told me not to worry about the pounds because I might still be losing inches. However, I do not really see much of a difference is this happen to any of you, if so any tips?
      Thanks
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
      · 0 replies
      1. This update has no replies.
    • KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×