VSG vs. DS (Sydney, Aus.)

[K-J]

Hi @more2adore

Nottle did my surgery here in Melbourne. I was a revision with two prior bariatric procedures having failed.

I went from 136kg to 76kg, have had a regain of 6kg from my lowest weight post op. The surgery for me has been a huge success.

He is certainly one of the best, if not the best bariatric surgeon in the country. Competence wise he is certainly the best choice in Australia for a DS. Having him agree to do it is another matter.

There is no one local to you in Sydney who will do them. James Ritchie used to, did a series of 200 and published research but no longer does the procedure.

Your shit out of luck with Insurance here. Unless you have had it 12 months they WILL NOT PAY. I've never heard of a carry over of benefits from another country, you could try to fight that but generally speaking insurance falls into two categories, Covered and Not Covered. If its covered under your policy and you have served the waiting periods your automatically covered. We don't have the issues of approvals and appeals here with our system like in the US. To pay out of pocked overseas might be a comparable option.

Feel free to PM me for more info. There are some other options.

K

 

[more2adore]

I PMed you. Thanks so much for responding to this thread!

 

[Parousia]

Hi there! Nice to have another Aussie resident here .

Prof Nottle did my surgery in February in the public system. Not sure whether you'd be eligible for that or not. Depends on your residency status. In any case, there is a one year waiting list. Went a few weeks over that, but that was better than I expected! If you have the surgery done privately using your private health insurance, there is still a pretty large gap. I believe it was in the region of $5,500, if I remember correctly.

As Kyal mentioned, Prof Nottle does have some fairly strict criteria he uses when deciding on your suitability for the surgery, but it's not very clear what those criteria are. I'll go through some points that I think made a difference for me:

1) Age. Not much you can do about that, but for women in particular, he seems to be happier doing the DS on older women, possibly because there's less risk of pregnancy during the major weight-loss period.
2) Prior unsuccessful weight-loss surgery. I had a failed lapband in 2006, so he knew that wasn't an option for me.
3) Multiple co-morbidities. I have sleep apnoea, high cholesterol, insulin resistance, migraines, Fibromyalgia and 3 herniated discs, as well as a family history of heart disease, amongst other things.
4) I have quite bad gastric reflux, which meant a VSG alone would be problematic for me, as the stomach is made smaller with a VSG than with the DS, in general, thus aggravating the reflux. Something to keep in mind if you're having a two-part DS.
5) I have to take NSAIDs because nothing else helps with my migraines, and I need them for my back pain as well. You cannot take them if you have an RNY.
6) He will also want to know that you have tried various other methods of weight loss before resorting to surgery (although he does see obesity as a disease and isn't surprised that people are unsuccessful with dieting, etc).
7) He must be convinced that you understand the importance of and will be compliant with your nutritional supplementation post-DS.
8) Last but not least, I recommend sending him an email with your story, asking him for his help, explaining why this is so important to you, and why you think the DS is the best/only option for you. Include as much relevant medical history as you can, touching on the points I've mentioned. Having it all laid out in an email not only helps you to have it all clear in your own mind, but also ensures that he knows your whole story (within reason, lol). Time is always limited in appointments, and it's hard to convey what you need to in that time.

A couple of other things to be aware of: I had a Skype appointment with Prof Nottle and my GP at her office, but he still wanted me to go to Melbourne for an appointment with him after that. She sent my medical history to him, which included a number of recent tests, so I didn't need to have everything done that he usually requires. I had numerous tests done when I went to Melbourne (from Adelaide) for my pre-admission appointment (which was actually multiple appointments with various medical personnel at the hospital, including blood tests). This occurred 8 months before my admission! I imagine this would be handled differently going through the private system, though. The other thing is, I don't believe psychiatric/psychological assessments are required in Australia for weight-loss surgery. I've never been asked to do one, at any rate.

I hope this helps. You are welcome to PM me if there's anything else I can help you with .

Best of luck with everything,
Beth

 

[more2adore]

That was so helpful, Beth, thanks. I do have Medicare - can you tell me how much it was out of pocket having it done publicly? Also, do you have a direct email address for him? I tried messaging through his website but got no response. Thanks!

 

[Parousia]

You're very welcome . The only out-of-pocket costs I had were the gap for my appointment to see him privately the first time, and then the cost of travel to and from Melbourne for the pre-admission appointment and the surgery, and about $100 for discharge medication. I'll have a look for his email address and PM you with it.

 

[K-J]

My out of pocked cost after insurance and medicare paid was in the vicinity of $5000.

Weight loss surgery is the second biggest medical ripoff only to plastic surgery which takes first place. However it may have been the best $5000 I ever spent.

 

[more2adore]

I'm still trying to figure this out, Parousia - from the research he's done, my hubby is SO sure that Medicare doesn't cover the surgeon's fees even when it's done via the public system. I'm so confused. I guess I'm still learning my way around the Aussie healthcare system and I have a lot to learn.

 

[K-J]

In the public system everything is covered. Free. Nothing to pay. Its part of Medicare. Downside is you need to be unwell to get on the waiting list and as bariatric surgery isn't emergent you will wait at least a year or more.

In the private system you will pay for a number of things and the money will come from a number of places. Including you.

1. Hospital fees / OR fees - Covered by private health insurance, thats its purpose mostly.
2. Anaesthetic - Medicare pay I think 75% and private health pay the other 25%. However they both only pay up to the medicare schedule fee which most doctors charge above because its both inadequate and/or they are greedy with lavish lifestyles. Thats how and why you end up with out of pocket costs.
3. Surgeons Fees - Same as for Anaesthetic fees.
4. Assistant surgeon fees - same as anaesthetic and surgeon fees.
5. Pathology and Radiology - same 75%/25% ratio as above. You may receive a bill for an out of pocket fee afterwards.
6. Your chosen hospital excess - you get to pay that. Mine was $250

When I had my surgery I had to pay the surgeons out of pocket fees and the anaesthetists out of pocked fees up front which was around $5000 from memory. That fee included the assistant surgeon as well. I received a bill from radiology and pathology after leaving the hospital which I was able to get knocked on the head. Also received an out of pocket bill for the Intensive care physician that was monitoring me post op as I was a high risk patient, another $350 cost to me.

You would be up for a good $15000 out of pocket without insurance I would think. Probably cheaper than the US and comparable to some of the Mexican and Brazilian surgeons though.

Hope that helps.

 

[Parousia]

I'm still trying to figure this out, Parousia - from the research he's done, my hubby is SO sure that Medicare doesn't cover the surgeon's fees even when it's done via the public system. I'm so confused. I guess I'm still learning my way around the Aussie healthcare system and I have a lot to learn.

As Kyal has said, under the Australian Medicare system you don't pay for anything as a public patient: no surgeon's fees, anaesthetists fees or anything else that is a normal part of your surgery and recovery while in hospital. The only thing I had to pay for was a $5 back sponge with a handle that the physio recommended. In that respect I think our public health system is far superior to that of the U.S. . That said, Peter Nottle will make the decision as to whether you qualify to go on the public waiting list, particularly based on your current health and financial need. He is the head of surgery for the unit that this surgery falls under.

Just a word of warning: I did experience some negative attitudes from some within the public hospital I was in because I was an Interstate patient using the Victorian health system. Health is a state responsibility, so it means you are using money out of the Victorian bucket of money (some of which comes from the federal government). Nevertheless, there is a legal agreement between states to provide health care to people from other states when required. Peter Nottle had no problem at all with the fact that I was an Interstate patient. He was more interested in my need and suitability for the surgery. I tried to make it clear to those who queried it (head of the Pre-admission Unit and a very rude man on the Respiratory team) that I had no choice. The surgery is not available in South Australia at all, so I had to go to Victoria.

Hope this helps .

 

[more2adore]

Thank you so much, Kyal and Parousia. You guys have been so helpful. I'm not sure if we'd qualify under the public system. My husband makes a decent salary, but I've been unable to find a job here, so we're actually a little more underwater every month. It'd be easily rectified if I could just get a job, but you know employers can be hesitant to hire someone of this size to start with, and then I have the fact that I'm not a Permanent Resident yet working against me as well (even though I will automatically get PR in two years as long as hubby and I are still married, which we will be. ) Still not sure if we'd qualify has having financial need, though.

As far as "being sick" goes, I have the following health issues:
asthma
sleep apnoea/sleep apnea
hypothyroidism
lymphoedema/lymphedema
knee pain for which I take a daily NSAID
Vitamin D deficiency (I take 5000 IUD a day in addition to a prenatal multivite)
acid reflux

I do not have the following comorbidities commonly associated with being superobese:
high blood pressure
high cholesterol
insulin resistance or diabetes
PCOS

So if we're not going to qualify for public, we'll have to wait until we can afford to do it privately, then, which means after I get a job... and who knows when that's going to be. Man. Once you decide you want surgery, you just want to HAVE it, you know?

 

[Parousia]

I understand exactly how you feel! I found the 1 year waiting period very difficult. Just so you know, it's more about convincing Nottle about your financial need than about specific criteria. All Australian residents are entitled to use the public health system, free of charge, no matter what their financial situation is (although I'm not certain about Temporary vs Permanent residents for elective surgery). But there are waiting lists, and quite a bit of demand, so you would be prioritised according to your need. I think your weight and health issues should be enough to convince Nottle that you need WLS. It's more the financial side you need to convince him of, but you don't need to go into great detail. General comments about the reasons you can't afford to do it privately right now, such as the cost of moving, not having a job (and the difficulty finding a job at your weight) etc. are relevant factors, especially if you don't have savings as a result of the move, as well as the fact that you're not coming out every month. Is your hubby an Australian citizen? Your Temporary Residence status concerns me the most with regard to eligibility, but if he is a citizen that may make a difference.

Love your user name, btw. Very cute!

 

[more2adore]

Thanks for the username compliment. I'm not quite a "temporary" resident, I'm a "provisional" one. Temporary residents aren't eligible for Medicare at all, but "provisional" residents (people who have applied for and/or been granted a spouse visa, as in my case) are. So I have a Medicare card just like anyone else and all the benefits that go along with that, fortunately. My husband is actually a permanent resident, but has just qualified for citizenship and will have it in the next six months. Doesn't change my Medicare status, though.

I'll send Prof. Nottle an email and see what kind of response I get. Thanks so much!

 

[Parousia]

Thanks for the username compliment. I'm not quite a "temporary" resident, I'm a "provisional" one. Temporary residents aren't eligible for Medicare at all, but "provisional" residents (people who have applied for and/or been granted a spouse visa, as in my case) are. So I have a Medicare card just like anyone else and all the benefits that go along with that, fortunately. My husband is actually a permanent resident, but has just qualified for citizenship and will have it in the next six months. Doesn't change my Medicare status, though.

I'll send Prof. Nottle an email and see what kind of response I get. Thanks so much!

Best of luck! Please let me know how it goes .

 

[more2adore]

Well, it took me a little while to get up the courage - but I took the first step yesterday and emailed Prof. Nottle. I gave him/his office ALL the details. Hopefully the email wasn't so long it deters them, heh. Scared, but fingers crossed I hear back from them!

 

[DianaCox]

I think it is a trip that YOU are expected to/can just email the surgeon and ask to be taken as a patient - or perhaps this is emailing the surgeon's OFFICE?