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Traveling for Bariatric Surgery – Why?

In 2017, about 1.4 million Americans left the U.S. to obtain medical care. And that number will grow by double digits this year. The reasons are many, but mostly it comes down to money. And a significant number of people are traveling for bariatric surgery.

A Shameful History of Discrimination

Health plans have long history of discriminating against people with obesity. It’s easy. Blame the patient and dodge the bills. Many folks living with obesity just shrug and move on. These days, for bariatric surgery, outright exclusions are less common than ever. But policies and procedures can be so convoluted that the effect is the same.

OAC Chair Michelle Vicari was shocked when her health plan turned her down for bariatric surgery in 2006:

I had a BMI well over 50, high blood pressure, unhealthy cholesterol, sleep apnea, and a host of other problems. I knew that my medical need for bariatric surgery was obvious. But my insurance turned me down. Repeatedly.

That didn’t stop her. She did her homework. She found a surgeon in Mexico with full accreditation and a solid reputation. Her local program would have charged her $65,000 back then. In Mexico, the cost was $14,500, including nine days for recovery. She paid the bill herself.

Vicari has no regrets. She could reach her surgeon by phone or email. And her local physician does periodic tests as needed to assure her that everything’s OK. Still, she cautions that this is not the ideal option if you need a lot of support.

Since 2006, the costs for bariatric surgeries has come down considerably. Vox tells the story of Tatum Hosea. She paid $5,000 for a gastric sleeve in Mexico. Her local program would have charged her $14,000. “It was the best decision I ever made,” she said.

An Option That Carries Risks

Good care – either at home or away – is never a guarantee. Especially if you’re traveling for bariatric procedure, doing your own homework is essential. A skilled, board-certified surgeon is critically important. A fully accredited facility should be an absolute requirement. Many other factors come into play. If you want an exhaustive list, check out this position statement from ASMBS.

You’ll see plenty of caution there. And for good reason. As with any surgery, complications can be serious or fatal.

Needlessly Difficult Choices

The bottom line is that traveling for bariatric surgery would not be anyone’s preference – if not for money.

Let’s face it. We spend a lot of money on medical care. But we spend it in some very odd ways. We buy health insurance to shield ourselves from big expenses. Or maybe our employer buys it for us.

Unfortunately, when it comes to obesity care, all too often we find that somewhere in the process someone decided we don’t need it. That’s a bad decision. And one bad decision sets the table for some difficult choices.

The real solution would be more rational policies across the board for obesity care. Everyone who needs bariatric surgery should have access to care – free from petty exclusions and hurdles.

But for now, traveling for bariatric surgery might make sense for some people who do their homework very, very carefully.

Click here for more from Vox. For more of Vicari’s story, click here.

Going Home, photograph © Marco Nürnberger / flickr

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October 10, 2018

2 Responses to “Traveling for Bariatric Surgery – Why?”

  1. October 10, 2018 at 2:34 pm, Allen Browne said:

    The biggest problem with traveling for bariatric surgery is that it fragments the weight management that is so important for a patient with the disease of obesity. While bariatric surgery is an important part of a weight management program for some people, it should not be done in isolation from the other elements of comprehensive weight management – evaluation of psycho-social modifiers of the energy regulatory system, dietary training, activity training, mental health support, the option for pharmacotherapy, the option for device therapy, and the option for pharmacotherapy after bariatric surgery.

    To fragment the care of patients is not good for the patient and is not good for the reputation of the bariatric surgical procedure. The disease of obesity is currently chronic and incurable. Bariatric surgery does not cure it. Comprehensive,multidisciplinary care should be utilized and available before and after any surgical procedure. Unfortunately our system of financial support for comprehensive multidisciplinary care for the disease of obesity is no better than the financial support for bariatric surgery alone. Truly a sad state of affairs.

  2. October 10, 2018 at 3:16 pm, Ted said:

    You are absolutely right, Allen.