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.

Good luck! It would have cost >$25,000 to get the WLS in Memphis, and the only surgeon doing it at the time had only done a handful of VSG's. I went to WeightWise just outside of Oklahoma City to a MD who had a long record of successful VSG's. It only cost me $10,000 for everything, plus a year of unlimited follow ups with my doctor. Of course, I only went back for my f/u appts through 6 months...it's a long drive from Marion, Arkansas. I know I made the right choice for me. It sounds like you have done your research and have made a very well informed decision. Congratulations and Good Luck.

Deanna

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.

Now, see, this is why I'm concerned that this is yet another one of those forums that pushes one doctor while dissing another. I can't seem to find these elusive people you speak of who have problems with Dr. Joya's ethics and have gone to see him. Who are they? Where can I find them to talk to them? Every single person I've spoken to that has gone to Dr. Joya has had nothing but good things to say about him and his staff, OR their ethics.

When Gerald, his U.S. based assistant sent me the information, there was a very clear stipulation in the paperwork that talked about the complication insurance, and their policies about complications. No secrets at all there. I've talked to people who have said they went for a bypass, but Dr. Joya talked to them about the sleeve maybe being a better option for them. So is he pushing bypass, or is he simply talking to people about THEIR best options?

I talked to a lady today who researched Dr. Joya for almost 10 years before finally deciding to go get a Sleeve surgery from him last year. She said she also heard rumors about the nicked liver (all the way from the patient died to the patient had issues to there was no patient), but never once could find the name of that person or talk to that person about their experience.

Every single negative thing I've heard about Dr. Joya (and there hasn't been much) has been very nebulous and has no actual stats attached. Every single positive thing I've heard about Dr. Joya (and there have been many) has contained statistics and names of people. It really concerns me that this might be yet another one of those sites that promotes Dr. Aceves over any other, as if he's a sponsor of this site, and sends out negative information about other doctors, even if there is no real evidence of such happening.

Yes, I've heard a couple people talk about having leaks from all of the doctors - docs don't use statistics in their stats of patients who experience issues months later, only those that experience issues early on. Did these people burst their staple lines and get leaks by overeating before they had healed? Did they begin on solids sooner than they should have? Were they anomalies? Or was it really a surgical issue? Nobody can say or give facts.

Please, just let me know - I'm not here to cause trouble or whatever, but if this is another site that is going to play the "my surgeon is better than yours" game, I'll just opt out now while it's early. It is good to give people information so they can make informed choices, but only if that information is actually factual. Where is the evidence that Dr. Joya has treated people in an unethical manner? Not rumor - evidence.

Thanks

Now, see, this is why I'm concerned that this is yet another one of those forums that pushes one doctor while dissing another. I can't seem to find these elusive people you speak of who have problems with Dr. Joya's ethics and have gone to see him. Who are they? Where can I find them to talk to them? Every single person I've spoken to that has gone to Dr. Joya has had nothing but good things to say about him and his staff, OR their ethics.

When Gerald, his U.S. based assistant sent me the information, there was a very clear stipulation in the paperwork that talked about the complication insurance, and their policies about complications. No secrets at all there. I've talked to people who have said they went for a bypass, but Dr. Joya talked to them about the sleeve maybe being a better option for them. So is he pushing bypass, or is he simply talking to people about THEIR best options?

I talked to a lady today who researched Dr. Joya for almost 10 years before finally deciding to go get a Sleeve surgery from him last year. She said she also heard rumors about the nicked liver (all the way from the patient died to the patient had issues to there was no patient), but never once could find the name of that person or talk to that person about their experience.

Every single negative thing I've heard about Dr. Joya (and there hasn't been much) has been very nebulous and has no actual stats attached. Every single positive thing I've heard about Dr. Joya (and there have been many) has contained statistics and names of people. It really concerns me that this might be yet another one of those sites that promotes Dr. Aceves over any other, as if he's a sponsor of this site, and sends out negative information about other doctors, even if there is no real evidence of such happening.

Yes, I've heard a couple people talk about having leaks from all of the doctors - docs don't use statistics in their stats of patients who experience issues months later, only those that experience issues early on. Did these people burst their staple lines and get leaks by overeating before they had healed? Did they begin on solids sooner than they should have? Were they anomalies? Or was it really a surgical issue? Nobody can say or give facts.

Please, just let me know - I'm not here to cause trouble or whatever, but if this is another site that is going to play the "my surgeon is better than yours" game, I'll just opt out now while it's early. It is good to give people information so they can make informed choices, but only if that information is actually factual. Where is the evidence that Dr. Joya has treated people in an unethical manner? Not rumor - evidence.

Thanks

No, this is not a board to push one doctor over another. It does happen to be that many here were operated on by Dr. Aceves but he has nothing to do with this website. I know I never suggested you go to Aceves. I never suggested ANY doctor to you. I just told you a bit of what I know about Joya, that's all. So unless you can show me where I pushed him on you I'm not really sure how you can suggest that this board pushes any given doctor.

I have never ever claimed that Aceves was the only good surgeon. I have always pushed research, LOTS of research. Rumbaut is excellent as well. There used to be another one but his location is so bad and dangerous that I do not suggest him and he's been having a lot of problems lately. People coming home and having to have emergency surgery to fix something that went wrong.

The person that had the liver issue with Dr. Joya posts here. She's been posting this morning. It's in her OH profile, or it used to be. She does not blame Dr. Joya for the liver issue... it happens. It's a risk with this surgery. Her issue was that nobody told her she would have to pay the additional $1200 until the day of her discharge and they were not open to her leaving the hospital until it was paid. They were very limited in forms of payment they would take. Had she known this up front when the complication first happened she would have had more time to prepare and take care of the additional bill. He had no complication fund before that.

And speaking of the "complication fund," most of the good surgeons in Mexico cover complications themselves. Consider this, he claims complications happen in less than 1% of his cases. $500 x 100 is $50,000. The liver complication was $1200. That would mean he's making a pretty good profit on his complication fund. Complications are very unlikely to cost $50K in Mexico. Again, in my mind it goes back to ethics. You are okay with this and that's fine. I am not, I see it as an issue of ethics. It is not a matter of my doctor is better than your doctor, it is a matter of I require different things from my surgeon than you do and again, that's okay. That's why there is no surgeon that is a one size fits all kinda person. We all require different things from our surgeons.

Leaks... they happen. So be it, all surgeons have them eventually. Nobody is downing Joya for having a leak. That wasn't the issue. It was his telling someone that leaks are basically easier and safer with bypass than sleeves. That person also posts here. She had her consult the day before surgery with Dr. Joya and he encouraged her to get a bypass instead of a sleeve. She was in a mad dash the night before surgery to research bypass. She ended up with a sleeve. She is also the one that explained about the person that had a leak and was still battling it 4 months later. The person was there while she was.

I have to say, I stand behind my original post. I've been reading WLS boards for a long time and after time you can see trends with doctors. Some doctors have more issues than others. Some are flat out liars. Over time you see trends on various doctors.

Dr. Aceves is probably the one in Mexico that does the most sleeves so you are going to see a lot of his patients posting. It's the way it is, it will be the same on any board where a lot of Mexican sleeved patients post. That doesn't mean he has anything to do with this board, he simply does more sleeves than other doctors so I'm not sure it is fair to jump to the assumption that he has something to do with this board. Really, it's kind of unfair to the man IMHO.

Hi Wasa - thanks for your PM clarification and for giving me the links to the threads. I appreciate them very much.

I don't see where they make Dr. Joya look unethical, though definitely things could have been handled better regarding the nicked liver situation. Her issue wasn't that her liver was nicked (it was enlarged and that can happen) - it was that Natalie didn't tell her until she was preparing to walk out of the hospital that she had to pay the $1200 additional before she could leave. Not a very good administrative decision, and it was stress for her that she didn't need. The hospital should have told her husband immediately while she was in recovery about the additional charges, so he could take care of it before her discharge, and avoided the extra stress.

As to the man with the leak - again, very sad situation, but also happens, especially in older patients who have other issues, and I don't see where Dr. Joya was unethical there, either. In fact, the poster actually complimented the Doctor that he tried his best to get rid of all the costs he could, but that he could not get rid of the hospital charges themselves for four extra weeks in the hospital. He stated that Dr. Joya, Natalie, and the hospital staff were all very kind and professional with him in the extra time he had to spend in PV. He said he ended up paying double what he had paid for the initial surgery - that is $10,500 more - for FOUR EXTRA WEEKS in a hospital. My guess is they discounted him pretty heavily to get it down to that.

Thing is, these things do happen - anywhere. They happen often in the U.S. Though I'm sure it was scary to have to stay an extra month in a foreign country for surgical complications, that is a chance we take when leaving the country for surgery.

The woman who talked to Dr. Joya and he mentioned the RNY said this:

Thanks all!

I didn't feel he tried to convince me (he was recommending) and didn't feel trapped at all! Also I didn't feel it was money-related. I think he is very skilled with both RNY and sleeve. He is straight-forward and expressed his point of view in my case once I explained my feelings and concerns.

At the end of the day, the told me it was MY choice, that it was a big commitment and that I had to go with what I am comfortable with.

He seemed so at ease in his recommendation of the bypass for me that I had to question myself....but at the end of the day, I feel I have to stick to what I really wanted, the sleeve (thanks MWG)

And thanks to you all, you are a great board!!

Again, in this situation, the person said she did not at all feel pressured into getting the RNY, but that he was giving her options. To me, that is just what a surgeon should do - provide options and allow the patient to make the best decision to fit their needs and/or fears.

At the end of the day, while these situations were unfortunate, I don't see any unethical practices. I see a really crappy situation where they should have told a client earlier so that she owed more money.

In the long term, from what I can gather, it was exactly the two situations - the liver laceration and the leak complication - that caused Dr. Joya's office to set up the complication fund - so that these types of situations would be minimized to the best of their ability. Rotten that they happened, but a good thing came of it and the complication fund was born within two months of the lacerated liver situation and two weeks after the leak complication. I think it is highly ethical to set up a way for this not to happen again.

I do think it's great that a few of the other surgeons seem to cover for any complications (Aceves and Alvarez, to name two), but I'm not surprised that it's not across the board. Sometimes the surgeon has no say in what the hospital charges. He might waive HIS fee, but the hospital will charge additional fees that the surgeon often has no control over.

Again, thanks for voicing your concerns, though, and for giving me the threads to read over. It's all about being armed with all the information so we can make good choices, and I APPRECIATE being armed :frown1:

And I think Wasa was pretty clear, that if you don't see any problem with it and your ok with that, then that is ok. She is just stating that she wouldn't be ok with that.

So I think your both in agreement here, these things don't bother you. If they don't bother you, then don't worry about it.

I will say something almost totally unrelated, but kind of relavent since you mentioned it. I personally, didn't really like PV as a vacation spot. Again, this is just my personal opinion, but the Water was colder then I care for, but if you again, if that doesn't matter to you, then it may be a great location. Kind of similar??? For vacationing, I prefer the Carribbean side of Mexico.

My surgeon doesn't bill his time we have complications. It's included in our two years of after-care. But the hospital certainly charges us! He said he can't help that.

OTOH, my insurance said they'd cover most stuff, which would not be an option if I'd gone to Mexico. I was self-pay here, but my insurance covered everything but the surgery.

As to the man with the leak - again, very sad situation, but also happens, especially in older patients who have other issues, and I don't see where Dr. Joya was unethical there, either. In fact, the poster actually complimented the Doctor that he tried his best to get rid of all the costs he could, but that he could not get rid of the hospital charges themselves for four extra weeks in the hospital. He stated that Dr. Joya, Natalie, and the hospital staff were all very kind and professional with him in the extra time he had to spend in PV. He said he ended up paying double what he had paid for the initial surgery - that is $10,500 more - for FOUR EXTRA WEEKS in a hospital. My guess is they discounted him pretty heavily to get it down to that.

This brings up a good point, the cost for 4 weeks in the hospital was $10,500 yet that complication fund pays him (according to his own stats) $50K per each complication. That's a big profit. Is he a doctor or an insurance company?

Thing is, these things do happen - anywhere. They happen often in the U.S. Though I'm sure it was scary to have to stay an extra month in a foreign country for surgical complications, that is a chance we take when leaving the country for surgery.

I agree completely, I never blamed him for the leaks or liver laceration. I made it really clear that all doctors are going to have leaks and complications eventually. It's not the leak, it's the costs involved.

The woman who talked to Dr. Joya and he mentioned the RNY said this:...

That wasn't my issue. My issue is when she originally wrote THIS:

Hello everyone,

To make a long story short I am right now in Mexico. i am supposed to be sleeved tomorrow. I met my surgeon today and he recommends me the bypass after discussion. My main concerns are leaks and he told me in those terms the bypass is safer.

My problem: I don't know anything about the bypass and I have just read negative stories about dumping, Vitamins deficiencies and fatigue...

I don't know what to do, I am lost, How is your life with the bypass. I am a low BMI, is it too invasive for me? Is the life change too radical??

It is the first time I come on this board, I hope you can help!

Thanks so much. I have to take a decision for tomorrow at noon!!!

Since when is bypass safer than a sleeve? Since when is a bypass leak safer than a sleeve leak? That's just untrue information.

At the end of the day, while these situations were unfortunate, I don't see any unethical practices. I see a really crappy situation where they should have told a client earlier so that she owed more money.

This is where we will have to agree to disagree. It is as I wrote earlier, what matters to me is different from what matters to you. That's how life works, we all HAVE to find a doctor that meets our individual requirements. We did that and that is all that matters.