Vent post. Drs in US won't see me because I had original surgery in Mexico

[VSG.LinZee 36]

So Frustrated. Had VSG several years ago in Mexico, but struggling. My primary care dr referred me to the local Bariatric surgeon in my area, and they're the only ones covered by my insurance. After I told them I was sleeved in Mexico originally, they refused to see me. I'm sad and frustrated. I really don't want to go to Mexico again for a revision (not that it wasn't a good first experience, just I have a family and kids now, so the cash isn't there to get it like it used to be.) This is just a vent post. I'm just sad about the situation.

[Tomo 1,196]

That's strange. When I was talking to several doctors for a possible revision, not one asked or cared where I was sleeved.

[VSG.LinZee 36]

every doctor covered by my insurance (Tricare) within a 200 mile radius won't see me. I've called everyone.

[ShoppGirl 5,072]

I would contact your insurance company and let them know the situation. Maybe they will open you up to see surgeons out of network. I believe they have to cover someone willing to see you. I ran into a similar situation with my husband and unfortunately it was cancer that needed to be removed so there was no time to fight with the insurance and we had to go out of network. Nothing to do with Mexico, just that the surgeons in his network were afraid to do it because of the location. Anyways, you just reminded me that I want to try to do a dispute now and see if they will cover it. It’s a long shot to do it this way but worth a try. If you do it up front though, you may actually have success.

[ShoppGirl 5,072]

If I were you I would contact your insurance and see how to open a dispute or whatever they call it and then ideally get a family dr or someone in your corner (even my gynocologist told me if I had issues getting approval that he was willing to help) hopefully they will be willing to write a letter saying it’s medically necessary (if you even need that) and you can add that you called everywhere within 200 miles and go from there.

[KimA-GA 540]

check with your insurance. Some have blocks from providing care directly related to a self pay procedure, even years after the fact. That could be why you are having trouble.

[kcuster83 1,505]

Wow, that is crazy. How is it any different than if your original surgeon retired or something? You would need a new one? Makes no sense.

Sorry, I hope you get it worked out.

Do you have to tell them you were sleeved in Mexico?

[ShoppGirl 5,072]

4 minutes ago, kcuster83 said:

Wow, that is crazy. How is it any different than if your original surgeon retired or something? You would need a new one? Makes no sense.

Sorry, I hope you get it worked out.

Do you have to tell them you were sleeved in Mexico?

I would like to think that they would look at records from the original surgery at some point and figure it out, but then again they may just do imaging to see what they are up against and not pay much attention to what could’ve changed over all those years. I think you have a point, maybe just don’t volunteer that info unless they ask you specifically where the surgery was done.

[VSG.LinZee 36]

12 minutes ago, kcuster83 said:

Wow, that is crazy. How is it any different than if your original surgeon retired or something? You would need a new one? Makes no sense.

Sorry, I hope you get it worked out.

Do you have to tell them you were sleeved in Mexico?

Well, I was thinking maybe if I made an appointment at another place, I wouldn't even tell them I had surgery at all. Heck, I gained weight back and am now a candidate for surgery again LOL. But I think there might be staples or something in from the original surgery, so I would THINK they would be able to tell?

[VSG.LinZee 36]

1 hour ago, ShoppGirl said:

If I were you I would contact your insurance and see how to open a dispute or whatever they call it and then ideally get a family dr or someone in your corner (even my gynocologist told me if I had issues getting approval that he was willing to help) hopefully they will be willing to write a letter saying it’s medically necessary (if you even need that) and you can add that you called everywhere within 200 miles and go from there.

The problem isn't with my insurance, they're fine with it. It's the actual doctors. They won't see me.

[kcuster83 1,505]

1 minute ago, VSG.LinZee said:

Well, I was thinking maybe if I made an appointment at another place, I wouldn't even tell them I had surgery at all. Heck, I gained weight back and am now a candidate for surgery again LOL. But I think there might be staples or something in from the original surgery, so I would THINK they would be able to tell?

They would DEFINITELY know you had surgery. And, you would hate for them to find out while you're already under and on the table and then they stop. Never hide medical information. It is only a risk to yourself.

Plus, I actually think they would learn along the way with the pre-op testing. For example, most people need a EDG so I would think they would see it right there.

Just leave out the "Mexico" part. haha

[Sleeve_Me_Alone 657]

I had VSG in Mx and this has not been my experience so I'm so sorry you're going through this! I would consider not telling them where you had it done, it truly does not matter and is not material to your treatment going forward.

[ShoppGirl 5,072]

This is really bothering me. I know you said you are just venting but I’d really like to be able to actually HELP you because this is just so absolutely unfair. If you are just venting tell me and I will shut up but I hate to hear about things like this.

I have never heard of the blocks that KimA is speaking of and if that’s the case at least you have some explanation although I think I would still dispute it with a doctors help. But if what she is saying is not the case (your insurance company does cover it) maybe the insurance company can make them help you OR find you someone who will by making an exception for you to go out of network. Maybe start by asking the dr office WHY. Whether it’s because of insurance or just their personal preference or what.

Idk. I just wouldn’t give up quite yet. If it is not an exclusion from the insurance I believe they HAVE to find you a qualified provider to help you. If the doctors in their network refuse to see you they have the ability to cover you to see an out of network provider and cover it at an in network rate (basically just allow you to see any dr you want and cover it as if they are in your network). I believe you really do have a case in which this could be approved. it may take some work on your part but you really don’t have much to lose for trying except a bit of your time.

[oldandtired 238]

I too have Tricare. It might just be an excuse, as quite frequently some doctors won't take Tricare. Doesn't pay enough.

A thought: make them put it IN WRITING why they refuse.

[ShoppGirl 5,072]

13 minutes ago, kcuster83 said:

They would DEFINITELY know you had surgery. And, you would hate for them to find out while you're already under and on the table and then they stop. Never hide medical information. It is only a risk to yourself.

Plus, I actually think they would learn along the way with the pre-op testing. For example, most people need a EDG so I would think they would see it right there.

Just leave out the "Mexico" part. haha

Yea i agree. I believe a revision surgery takes longer so if they opened you up and found out they very well could close you up because they did not allow enough time to do the revision. Or get the scans that they needed ahead of time in order to proceed or whatever. I personally wouldn’t want them to be any less prepared than they could be when they cut me open either.