So we let our PCP (Internal Medicine) know that we're going to Mexico (Dr. Alvarez) for the sleeve, and she called my husband today to express her concerns. She is a very kind, concerned, dedicated doctor. We didn't ask to see her for pre-op but once we told her about the surgery, she said she'd like to schedule pre-op care to make sure we were in good shape for it.

Today, she called because she wanted us to know that she can do pre-op visit but cannot put down on paper that we are ready, cleared, etc. We are going to Mexico largely because our insurance does not cover surgery so it's all self-pay for both of us so from an insurance perspective it's not a big deal..maybe? (I think. I don't know how that impacts post-op).

She also said that a surgeon needs to do post-op care if any, that she can't do it. She emphasized that if there were complications, we would be hard-pressed to find a doctor here who would take on care for a procedure performed by an out-of-country doctor. Note that she doesn't know Dr. Alvarez and her comments are not directed at him in any way, just generalized concern from a US doctor about surgery in a different country.

All the stuff that you really don't want to hear as you are a bit concerned about surgery! But now I have a few questions.

1. What does post-op care from a doctor really involve?

2. How were you able to find someone to take on your care after surgery abroad?

3. Are we doing more harm than good by going to her for pre-op because if she puts something down on our charts saying she is not "clearing us" (whatever that means), and if we need something post-op, can the insurance use that to turn down claims for routine after-care?

Thanks for sharing your experiences on this front.

I did not go abroad to have surgery, however, I did self pay another doctor outside of my Kaiser *** network to have the surgery. I worked with my Doctor before surgery to lose weight but unfortunately I didn't qualify under Kaiser's program. She was extremely supportive before AND after. She agreed that afterwards she would help me with monitoring my blood work and sharing those results with the other doctor.

Honestly other than going in for blood work I have had no reason for any kind of aftercare from my PCP. I have been lucky with no complications, a great support group from both my insurance and my surgeon. Since I was self pay at another hospital, part of that payment was in the form of an insurance policy so that in the case something would have gone wrong, the other hospital would have picked up the costs.

It sounds to me as if your doctor is doing some CYA and it might be time to find a new one..just my two cents.

Before you head off to Mexico or give them any deposit, you need to check your insurance policy handbook and see if there are any coverage limitations for complications of surgery performed outside the US. If it doesn't specifically say it won't cover medical costs of complications, then you don't have to worry about insurance not covering you if you have a problem post-op.

I agree with Maharet, you should find a new GP because this surgery requires a lifetime of follow up and it's best to find a supportive doctor. The first big post-op testing you'll need is bloodwork at 3 months post-op to make sure you are not suffering any vitamin/mineral deficiencies among other things. Internal Medicine docs certainly can do post-op care, they do it for all sorts of surgeries, not just bariatric. Your doctor is just trying to avoid potential liability.

As for not "medically clearing" you, this is irrelevant because your insurance isn't paying for the surgery. It behooves your surgeon in Mexico to medically clear you before surgery, however. If you determined there are no coverage limitations in your insurance policy regarding surgical complications then it doesn't matter if you've been cleared for it in the US or not, unless Dr. Alvarez requires it. Still, I say find a new GP.

I actually don't disagree with what you PCP decided. She obviously cares for you and is trying to do the right thing, but she is also probaby trying to follow what her malpractice carrier would want her to do (or if she's in a group practice or a health system employee, that is another consideration). I haven't needed a PCP for any of my after-care--it has all been done by my surgeon and his PAs. I do think if you can find one who will do it, it would be better to have a surgeon here do your after care. Also, it's important to work with an RD who is well-versed in bariatric diets. I give mine as much credit as my surgeon for my success. It sounds like your doctor is willing to do some pre-op testing for you, which is probably more rigorous than what is done in Mexico, and I would take her up on it. Again, she probably can't sign off on it for malpractice/liability reasons--and if she coded it specifically as pre-op, who knows if your insurance will cover it. If she can work it in as routine/preventive care, which most of it probably is, it may help you get reimbursed. Curious to know what others do for after care when they have surgery in Mexico.

I had my surgery in the U.S. but spoke with a gal locally who went to Mexico and was seeing a local bariatric surgeon (not mine) for her follow-up care. I don't know if she set it up pre-surgery or when she got home. She's a year out.

So maybe check around in your area?

I just had surgery in Mx last week, so i'm not an expert on all the follow up. Originally when I discussed my intentions with my PCP prior and he was not keen on the whole Mx thing. I think it's just a typical response from lack of information. The care I received in Mexico was BETTER than the care I feel I have received in the past in US. Not so much in the actual medical care, but in the attitudes of the people performing their duties. Most of my US hospital experiences have felt like an assembly line conveyor belt sort of thing. Insurance companies and lawyers have ruined the US medical system... but I digress.

Once I explained that the follow up shouldn't be anything more than blood work and nutritional recommendations he was on board.

Thanks for the very helpful suggestions. Based on this, I think I will go for the pre-op, chat with her on follow-ups which will be exactly what she does to keep me healthy anyway (blood work, nutrition, etc.), and reassure her that we have a plan for complications. We will also share Dr. Alvarez's credentials and track record with her so she can get more comfortable with all of it.

She truly is an amazing, intelligent, very nurturing doctor who takes TIME with us, and I believe, at the end of it all, she will do whatever she can to keep us healthy. But I think she is worried about us, there are CYA/legal issues etc. that she needs to deal with, so I will do my part to reassure her.

Biggest thing is education on the part of the PCP (your educating them) on the MD and giving them as much information and reasurence as possible. Unfortunatly, Americans in general have a preconcieved idea that our way is the best and only way but that just is NOT true...its good that you do this before surgery though so that your PCP will be more comfortable in following up (as it really is only about labwork and wt. loss monitoring)...i had mine last week and just had my first PCP follow up for 1 week PO and she has been impressed with the care we have recieved and also with the surgical report that we recived from our MD in MX. It explained everything from medications we used to pre and post surgical findings and if any complications, ect. We (hubby and I) are doing great...he is 3 weeks po and i am 1 week...most doctors are OK as long as they have a way to contact the MD if needed questions arrise or need information, ect...I plan on going back at one month for FU and blood work...then 3 monthes...per my Mx MD sugestions...Our MD in the USA need more education and of course, going with a MD that is credible for sure...you have to do your research! Go to a HOSPITAL, not a CLINIC in a strip mall! I went with Dr. Garcia at Oasis of Hope/Florenece Health at www.ready4achange.com and i would do it again in a heart beat!!

I also went to Mexico to see dr Garcia at Florence oasis 8 weeks ago and the care I received was top notch! Better than any surgery I had in the US that's for sure. I went for a revision from the lapband which I had done here but my lapband dr wanted me to gain 30 lbs in order to revise despite the fact I was having issues before he would submit to my insurance. So off to Mexico I went. Once I got there they did several exams and panels of blood work to make sure I was ok for surgery. I plan to see my pcp once I'm 3 months po for my annual physical and blood work. I will tell him I had the sleeve just as I did with the band and he asked no questions. Hoping for the same this time. If not I do have a back up bariatric dr that will see patients that went to Mexico that's about an hour away.

I saw my PCP yesterday. I brought Dr. Alvarez's book with me. She copied the page with the necessary post op blood work I'll need, and scheduled me for a follow up appointment 6 weeks post op. She's 100% supportive, doesn't anticipate any problems, and believes I made a good decision based on the issues I had with my insurance denial. I didn't ask my insurance company if they'll cover post-op complications, but they won't be pre-existing conditions, so I don't think they can refuse to pay. And I don't think having the surgery out of the country will be reason enough for denial. I'm not anticipating any problems, but if they occur I'm prepared for a battle with HealthChoice. I couldn't argue with their policy that I be employed with the company for 24 months, but I wasn't going to wait another year for the surgery.

I saw my PCP yesterday. I brought Dr. Alvarez's book with me. She copied the page with the necessary post op blood work I'll need' date=' and scheduled me for a follow up appointment 6 weeks post op. She's 100% supportive, doesn't anticipate any problems, and believes I made a good decision based on the issues I had with my insurance denial. I didn't ask my insurance company if they'll cover post-op complications, but they won't be pre-existing conditions, so I don't think they can refuse to pay. And I don't think having the surgery out of the country will be reason enough for denial. I'm not anticipating any problems, but if they occur I'm prepared for a battle with HealthChoice. I couldn't argue with their policy that I be employed with the company for 24 months, but I wasn't going to wait another year for the surgery.[/quote']

Amy did you buy the book? I've been wondering if I should get it for my iPad/kindle.

I called Susan and she sent me the book in the mail. (I got it a few days later). I read it in a couple of hours. I wanted to leave it with Dr. Stine, but it's really written for the layman, not a Professional. She did write down the name of his web site. She would have done my pre-op labs but I told her they'll do them when I get there. She did my EKG and faxed it to Susan. She's awesome. Dr. Sandra Stine (Internal Medicine), Orlando, FL. I'm a RN, so I'm pretty picky about my Dr's.