? IF your ins paid for VSG, would you still go to Mexico?

AJW · July 1, 2009

I am sold on Dr. Aceves and am quite happy to go down there from So. Cal. to have this done, paying out of pocket. I checked with my husband's insurance carrier (HealthNet PPO) and apparently they are saying they will cover the sleeve if the doctor thinks it's medically necessary. In other words, just like they'll cover the band. It always has to be medically necessary for insurance to cover it. So my question to you all who have investigated this thoroughly, would you still go to Mexico (Dr. Aceves) for the sleeve if your insurance would pay? Keep in mind that my insurance won't pay every single penny of it - I'd probably still have about a $5K co-pay as that's the most I'm required to pay out of pocket a year for medical care. I know you'll say - depends on the doctor - and yes, I realize that. The doctor I've seen for the band consult also does RNY AND the sleeve. I'm now questioning HOW MANY VSG he's done. I guess I'll have to take him at his word. He works with Beverly Hills Physicians; they are all over the place and do a lot of different procedures both bariatric and cosmetic. So what do you think?:thumbup:

WASaBubbleButt · July 1, 2009

I am sold on Dr. Aceves and am quite happy to go down there from So. Cal. to have this done, paying out of pocket. I checked with my husband's insurance carrier (HealthNet PPO) and apparently they are saying they will cover the sleeve if the doctor thinks it's medically necessary. In other words, just like they'll cover the band. It always has to be medically necessary for insurance to cover it. So my question to you all who have investigated this thoroughly, would you still go to Mexico (Dr. Aceves) for the sleeve if your insurance would pay? Keep in mind that my insurance won't pay every single penny of it - I'd probably still have about a $5K co-pay as that's the most I'm required to pay out of pocket a year for medical care. I know you'll say - depends on the doctor - and yes, I realize that. The doctor I've seen for the band consult also does RNY AND the sleeve. I'm now questioning HOW MANY VSG he's done. I guess I'll have to take him at his word. He works with Beverly Hills Physicians; they are all over the place and do a lot of different procedures both bariatric and cosmetic. So what do you think?:thumbup:

My insurance would have covered my band and my revision to a sleeve. I was not willing to do the 6 month diet, etc., so I went to Dr. Aceves for my band.

When it came to my sleeve it was a bit different. I was *very* ill and really couldn't wait any longer to get the band out. I did not have time to jump through hoops to get ins approval for a revision. They actually wanted me to do a six month diet and I was at goal! I just did not tolerate a band, it was a horror.

I could have had the surgery done in my state but my state doesn't have a single revision surgeon I trusted. We are not one of the luckier states when it comes to revision doctors and not just anyone can do a revision. They are harder to do, carry triple the risk for leaks, bleeding, and perforation and it plain takes more skill than doing a straight sleeve. So I opted for self pay to Dr. Aceves.

So I really am one that ins would have paid for my surgery in the US but I opted for Aceves and the above is why.

How many has your local surgeon done? How many sleeves and how many bypass?

AJW · July 1, 2009

/ That's what I'm trying to find out unless there's some way to learn those stats on line. I'm in Calif. and this would be a first WLS issue. I understand about your situation, though, and why you wouldn't want to wait. My ins. does NOT require a 6-month medically supervised diet, however, so I don't think the wait/hoops would be long or difficult. The doc was ready to submit to insurance after the EDG except that I decided against the band.

Ruthi · July 1, 2009

I would still go to Dr Aceves due to his history of having no leaks, I couldnt afford to be sick and have to have another surgery afterward since I had had a major surgery to remove the band. I could have waited a year and have the VA do it but then I would have wasted all of the money I spent for the band with gaining back the weight.

AJW · July 1, 2009

Maybe I should have prefaced that question to ask "Those of you going for a first time WLS . . ." :001_tongue:

OK, here's the deal: I'm a great believer in following the way that the signs lead, ya know, as in the signs will point you to the best situation for you. So I had been emailing my doctor's office about getting information on how many VGS my doctor's done, and even emailed another doctor referred by somehow who's had RNY but her surgeon does the sleeve as well, and no reply so far. Then I get email back from Dr. Aceves' office (Nina) saying she explained to him (while he's on vacation, mind you) about my ulcer situation, etc., and he gave her an answer for me (which made sense to me as well) so we could go ahead and schedule it. Now MAYBE they're just needing patients, IDK, maybe things are a little slow for them, again IDK, but they came back with an answer. I've been waiting on my doctor's office for days now to come back with an answer and get nothing. I realize they may be busy and that's OK, but I take it as a "sign" that I'm supposed to follow along where the signs point. In other words, the path of least resistance is usually the right path to follow when you've "asked aka prayed" to be guided to the best situation for you. Call me silly, but it seems like Dr. A is still coming out on top here even though it will cost me more $$$ than going through my insurance. What do you guys think?:confused1:

WASaBubbleButt · July 1, 2009

/ That's what I'm trying to find out unless there's some way to learn those stats on line. I'm in Calif. and this would be a first WLS issue. I understand about your situation, though, and why you wouldn't want to wait. My ins. does NOT require a 6-month medically supervised diet, however, so I don't think the wait/hoops would be long or difficult. The doc was ready to submit to insurance after the EDG except that I decided against the band.

I could have also had surgery then appeal and be reimbursed but you know, in my particular state there just aren't any surgeons that I would have preferred. Not all states are like mine, most states are not. If the better surgeon was here, I would have stayed here but my state is not typical for WLS surgeons.

WASaBubbleButt · July 1, 2009

Maybe I should have prefaced that question to ask "Those of you going for a first time WLS . . ." :001_tongue:
OK, here's the deal: I'm a great believer in following the way that the signs lead, ya know, as in the signs will point you to the best situation for you. So I had been emailing my doctor's office about getting information on how many VGS my doctor's done, and even emailed another doctor referred by somehow who's had RNY but her surgeon does the sleeve as well, and no reply so far. Then I get email back from Dr. Aceves' office (Nina) saying she explained to him (while he's on vacation, mind you) about my ulcer situation, etc., and he gave her an answer for me (which made sense to me as well) so we could go ahead and schedule it. Now MAYBE they're just needing patients, IDK, maybe things are a little slow for them, again IDK, but they came back with an answer. I've been waiting on my doctor's office for days now to come back with an answer and get nothing. I realize they may be busy and that's OK, but I take it as a "sign" that I'm supposed to follow along where the signs point. In other words, the path of least resistance is usually the right path to follow when you've "asked aka prayed" to be guided to the best situation for you. Call me silly, but it seems like Dr. A is still coming out on top here even though it will cost me more $$$ than going through my insurance. What do you guys think?:confused1:

I can't answer that because I do not know who the other surgeon is you are considering. I do not know their experience, their stats, their rep, so I can't really give you an honest answer. I'm all for going with your gut but on an informed basis.

Sit down and write a list of pros and cons. See what you think.

As for Nina getting back to you right away, that is how they are. When I had a band on Christmas day I started having severe esophageal spasms. I knew what it was, it was double over kind of pain and it would hit me about 1 time every 3-4 minutes. Although I knew what it was I did not know what to do about it.

Dr. Aceves was on a cruise, they were having a family reunion. I called Nina asking what the heck should I do. I did not know Dr. Aceves was on the cruise otherwise I would not have called at all. She called him on the ship and he called Dr. Campos (asst. Surgeon) and asked if he would meet me at the hospital to do an unfill. Dr. Campos said of course.

I didn't follow through with it until the next day, I was not going to mess up everyone's family plans but my point is that really is how the staff are.

When I was having such horrible band problems Dr. Aceves had me come to Mexicali on a day when he didn't have many surgeries. He spent four solid hours with me, one on one doing every test under the sun. Four barium swallows (pouch obstructed, pouch opened, after drinking ice Water, etc.), an upper endo, xrays, the works. Know what he charged me? Nothing. He got the hospital to cut their fees to $25.00.

Yes, the office really is that way all the time. They are there for you before, during, and after surgery. I still call Gaby, their psychologist with questions periodically. (Body Dysmorphia issues.)

You have to figure out what you require from your surgeon and their staff. You have to know what you need from them and if they will provide and then you have to look at skill, experience, stats, and your comfort level. Not everyone is cool with going to MX and that's fine. You go where you feel you will get everything you require from a surgeon.

AJW · July 2, 2009

That's an amazing story. I don't know how to find out the stats on my local doctor. He has different offices he works out of. The coordinator for the office local to me, where I went for the band seminar, has been the most responsive. She sent my chart to his Beverly Hills office and that coordinator is not responsive at all. I finally just asked the responsive person to give me an answer on how many VSG he's done; she said she doesn't know, but would email the doctor and see what she can find out. This is about all I think I can expect as far as "above and beyond" the call of duty. Every story I hear about Dr. Aceves' group seems exceptional, and although this is just "perception" for me based on reading many people's stories, it's all I have to go on. I don't have any "inside" contacts to find out stuff about doctors as you apparently do, so most of my impressions/research is based on the experiences of others which as far as this doctor goes, have all been great and that's a good start.:001_tongue:

blueskidoo · July 2, 2009

Honestly, if my insurance covered the procedure, it would have cost me almost the same amount as going to Dr. Aceves. Between the type of coverage I have, and the US Dr. I would have used (he's out of network) and his "program fee" plus the extra days I would have had to stay in a hotel (just one night in the hospital with them) it was not much different cost wise.

But all I have heard about Aceves is amazing, and I really like the 3 days in the hospital, and the leak tests, and though I was nervous in the beginning about choosing a Dr., I really feel empowered being able to choose who and what is best for me, not just going with what the insurance thinks is best.

Malaika · July 2, 2009

I was a "virgin" sleever and yes, after doing all of the research that I did, even if my insurance would have paid for my sleeve surgery, I would have gone to Dr. Aceves. Three days in the hospital is awesome. Dr. Aceves comes and see you at least 3x a day. The hospital was immaculate. Everything was 100% better than you get in the US and the cost to me out of pocket would not have been that much less than what I paid to Dr. Aceves.

AJW · July 2, 2009

I'm in Los Angeles, land of everything cosmetic from WLS to cosmetics after WLS. There are doctors everywhere. My doctor here is with beverlyhillsphysicians.com. They are world-wide. The surgeon is Michael Feiz, M.D., he's the bariatric guy. I will be speaking to him soon to ask all those questions about his experience, of course, I'm sure he'll love me grilling him on his experience levels but that's OK. Re my insurance the most I can pay out of pocket for approved medical procedures in one year is $5,000. Of course IDK how it's handled if for instance the anesthesiologist is out of network or something; been there before and you just have to make a deal with them for cash. The hospital is separate from the surgery costs, naturally, but again all I'm responsible for is $5K. I will get to the fine print on that if I decide to stay in the US. The hospital would be Cedars-Sinai in Los Angeles. They have a weight loss center there so again, very experienced people. It will all come down to how comfortable I am with the doctor. He seems very good, but I don't know his stats, and doctors do have a tendency to gloss over details, especially when they "can" because they're in Beverly Hills. I don't live in BH, just saying that's where the group has one office. I'm sure I'd get much better personal attention with Dr. Aceves and his team, but there is a big difference in price from $5K to $9.5K. My husband is fine with whatever I want to do; I'm just trying to decide what to do. I've told Nina to set it up in August; we'll see what Dr. Feiz has to say about his stats, but again as I say, there's no way for me to call him on it if he decides to be less than forthcoming with me, kwim?!:wink0:

Malaika · July 2, 2009

Best of luck with your decision. And I see no reason why your doctor should lie to you. You could check the Medical Board to see if he's had any lawsuits filed again him. Also, you could check the civil court system to see if there have been complaints against him and read the complaint to see what the charges were. This is what I do for any doctor recommended to me in Nevada. Research is your best weapon.

Also, keep in mind that the cost of the surgery and all related expenses are tax deductible.

WASaBubbleButt · July 2, 2009

I'm in Los Angeles, land of everything cosmetic from WLS to cosmetics after WLS. There are doctors everywhere. My doctor here is with beverlyhillsphysicians.com. They are world-wide. The surgeon is Michael Feiz, M.D., he's the bariatric guy. I will be speaking to him soon to ask all those questions about his experience, of course, I'm sure he'll love me grilling him on his experience levels but that's OK. Re my insurance the most I can pay out of pocket for approved medical procedures in one year is $5,000. Of course IDK how it's handled if for instance the anesthesiologist is out of network or something; been there before and you just have to make a deal with them for cash. The hospital is separate from the surgery costs, naturally, but again all I'm responsible for is $5K. I will get to the fine print on that if I decide to stay in the US. The hospital would be Cedars-Sinai in Los Angeles. They have a weight loss center there so again, very experienced people. It will all come down to how comfortable I am with the doctor. He seems very good, but I don't know his stats, and doctors do have a tendency to gloss over details, especially when they "can" because they're in Beverly Hills. I don't live in BH, just saying that's where the group has one office. I'm sure I'd get much better personal attention with Dr. Aceves and his team, but there is a big difference in price from $5K to $9.5K. My husband is fine with whatever I want to do; I'm just trying to decide what to do. I've told Nina to set it up in August; we'll see what Dr. Feiz has to say about his stats, but again as I say, there's no way for me to call him on it if he decides to be less than forthcoming with me, kwim?!:wink0:

There is actually a great deal you can (and should) verify about any doctor.

I do not know anything about your doctor but you can research a great deal about him.

If you look at my sig link (I think it's there, I'll check after I post this!) there should be a link showing how to research a surgeon. It works for US or Mexican surgeons.

AJW · July 2, 2009

OK, some more questions: What do you do for pain meds after you leave Mexico? Do they send you home with Vicodin or get you a script that you have to get filled in Mexicali, or how does that work? What if you have an issue after you're home, some problem from the surgery? You can't go see the doctor you decided NOT to go to, so what to do about that? Yes, I understand you can call Dr. Aceves' office and get someone on the phone to discuss your issue, but if you need to be seen that's another trip back to Mexico. How did you resolve this in your mind before going for it?

WASaBubbleButt · July 2, 2009

OK, some more questions: What do you do for pain meds after you leave Mexico? Do they send you home with Vicodin or get you a script that you have to get filled in Mexicali, or how does that work? What if you have an issue after you're home, some problem from the surgery? You can't go see the doctor you decided NOT to go to, so what to do about that? Yes, I understand you can call Dr. Aceves' office and get someone on the phone to discuss your issue, but if you need to be seen that's another trip back to Mexico. How did you resolve this in your mind before going for it?

You really don't need narcotics after 3 days. They do send you home with pain meds but not Vicodin, that would be way too much at that point.

You can see your family doctor if something was wrong or if ... worse case scenario here... if you have a leak you can see any general surgeon. You wouldn't have to return to Mexico for anything unless you wanted to.