I have had my surgery in Mexico. For anyone that wants an honest accounting of the process and costs, I have laid it all out in detail here. I cover the emotional doubts, fear of surgery in a foreign land, financial truth and the outcome. You be the judge of whether this is right for you. For me, it was. Spoiler Alert: It cost me less than 1/10th of the US Price.
I am writing this about five days after having major total shoulder replacement surgery in Guadalajara, Mexico. This is the second article in a series and the context, rationale and lead up to this is here
Well the first and obvious noteworthy point is that I’ve had my surgery and I’m not dead. I can attest that if you choose to roam the world in search of medical surgery and settle on Mexico, that in my case, I didn’t die. I say that tongue in cheek because when I was telling people that I was going to do it, this is what they thought. I had so many naysayers who would spread fear that you won’t get a qualified surgeon or they won’t give you the best pain medication, or that you will get infected or diseased. In retrospect, it is laughable just how scared people can be and how they love to spread their own fears onto everyone else. Hindsight is 20/20.
What I am going to tell you applies to my own personal experience and of course, your mileage may vary. I will be honest and I have no reason to sugar coat this. I know just how important making the right medical decision is for you and you have to take ownership of your choices. I’ll tell you of my outcome so far and I hope it becomes helpful reference material that you may wish to review should you find yourself in a similar situation to mine.
I’m not going to understate that the lead up to this is scary. My wife and I boarded a plane from Phoenix, Arizona USA to Guadalajara, Mexico and as I was saying goodbye to my daughter I did have the thought of, “What if I never return from this?”. In retrospect, it was stupid to think that way but to say that I didn’t have those thoughts would be a lie. That said, nothing ventured - nothing gained, so off we went. I mean my shoulder isn’t going to magically fix itself.
About 6 weeks before we had made the same trip to meet with my surgeon, Dr. Gonzalez, and get this prepared. We had a tentative date set for surgery and planned for it. I was able to communicate with Dr. Gonzalez by email and I also called him on his cell phone to confirm logistics, etc. He had me get blood tests done in USA and send him the results about one week before surgery to make sure there were no issues. I found a local lab in Phoenix and had those tests done there. About US $165 all up.
While I was sitting in the chair having blood taken for the test, the nurse was telling me of her own medical insurance issues after giving birth to her child a year or so before and although her husband had health insurance from his work, she didn’t despite working in the medical field. They had to pay $800 a month to cover her health insurance on top of her husband’s employer provided policy. Clearly she was interested in my story. I realized how it was resonating with others that were not only uninsured but underinsured as well.
About 48 hours later the blood test results were in and I emailed the PDF of the results to Dr. Gonzalez, and waited for his reply. A day later his email reply came back giving me the all clear for surgery.
Even though we had a date for surgery and the medical green light to go ahead, scheduling the hospital turned out to be trickier than I expected. Private hospitals and free market healthcare means you have options and Dr. Gonzalez gave us many. Different hospitals are priced on different scales. They have different facilities and we reviewed four of them, eventually settling on Hospital Santa Maria Chapalita, a Catholic hospital in Guadalajara. I made this choice because it was middle of the road pricing but had an onsite ER facility. if there were any complications (and all medical surgery has some risks), they had the resources to deal with them. I researched what I could find on Google, Yelp, etc. and reviews looked good. It was also convienently located for my wife. I was told I would need to be in hospital for two (2) nights so my wife had to be able to easily Uber from our AirBnB to the hospital as well.
After a day or so of scheduling I got an email from Dr. Gonzalez that surgery was scheduled for 11AM on the date we had booked and it was expected to be a 3 hour procedure. We locked in the airline tickets for a couple of days before and packed. This is the time things get real. All the preparation goes from an academic study to reality really fast. When we landed from the 2 hour flight, every activity like taking my luggage oof the baggage carousel comes with the thought, “Soon I won’t be able to do this for a while without help.”. The Uber trip to our hotel comes with the thought, “Note the bumps and road quality because soon you will be wincing from pain from each bump”. Even staying at the hotel and remembering the incredible Steakhouse restaurant down by the valet parking area comes with, “How are you going to enjoy a ribeye sdteak when you can only use one arm?” These might seem like trivial or stupid thoughts but they are reflective of the fear that is natural; the fear that is exasperated by surgery in a foreign land.
Two hours prior to surgery, we turn up to the hospital - immediately coming face to face with language issues. The security guy at the admissions doesn’t speak English - he shouldn’t either. I’m in his country. “When in Rome....”. Enter Google Translate on my phone.
After a lot of nodding and him reading my doctor’s note I presented to the hospital, he takes us over to admissions and we sit down to speak with the girl who handles admissions. And (again), it is in Spanish. We manage to get her typing into the computer for us and after about 10 minutes about 10 forms are put in front of us. All in Spanish. She tries to get someone who speaks English to translate, but there isn’t anyone there.
I know these types of forms. Waivers of liability, financial responsibility, etc. You realize that everything here is a leap of faith. So you sign the forms. They then take a payment on my VISA card. We calculate exchange rate that it was USD $1,250.00. Man that is cheap. It wasn’t until after surgery I learned this is just a deposit.
Finally the paperwork is done. They then send us over to comfortable couches in the waiting room for my doctor to arrive. While waiting there for an hour or so, you see others going through the same ordeal. My wife starts a conversation in English with a lady who was a mother of a girl in labor who was going into delivery to give birth to her child. We have been through that before. Some supporting conversations help. “Don’t worry, she’ll be fine.”, she said. You realize though that no-one is saying the same thing back to you. “It’s fine”, I thought. “This was my decision. I own it. I’ve done my research and this will be fine.”. Then my doctor arrives.
You are taken behind the doors that all the other patients go through before they begin their adventure. You get changed into a gown and you get put on the stretcher. My wife is with me still - I love her so much - she’s amazing. Holding it together like a super star. The doctor leaves to get prepared and staff wheel you off to surgery. All of a sudden you start realizing they all are speaking English. It seems that 75% of the medical professionals all speak perfect English. You eventually say goodbye to your wife and then the sense of release begins. At this point there is nothing you can do. It is like you are sitting in the roller coaster as it leaves the station for the ride of your life. You can’t get out. Just sit back and go with it.
Little things start to impress you. As they wheel you into surgery they have this automated conveyor system that you are moved through in a sterile environment before you end up in theater. I’ve never seen that before but what a great solution to preserve back health of the medical staff.
Eventually you are in the surgical room. You look up and see the bright medical lighting on the ceiling. There are about 7 staff around your bed. My doctotr is there with his assistants. The anaesthesiologist is there. Nursing staff, etc. They make smalltalk with you in English. I noticed one of the surgeons is taking photos withis phone, which I recognized as a Samsung phone. It is funny how those last images get burned into your mind. Eventually the anaesthesiologist gestures it is time, and then everything goes black.
You wake up sometime later. Step 1 - check your fingers. Do they still work? Yes. Check. Step 2 - naseous from the anaesthetic? Nope. Check. Step 3 - How’s my wife? She’s there. You speak briefly. All good. Check.
After sometime before you become lucid, you find yourself in this private room. Staring at you are images on the wall. You remember you are in a Catholic hospital because the image of Jesus on the cross is right in front of you. Maybe it is the narcotics from the surgery but you realize you are fine and look at what others had to go through in their life journeys. You feel humble and eternally grateful. Life is beautiful.
Some more hours pass and eventually you start to settle down and come to grips with your status. The doctor comes in and explains what prevailed. It took 5 hours - not 3. It was some of the most complex orthopedic surgery they have ever done. I knew the shoulder was the most complex joint but mine was super complex. They had to remove two titanium pins, install a custom built prosthetic, stretched and re-wrap muscles around it to lock it in place. The deformed head of my humerus that had been removed was reduced to half of its original size so installing the correct one is a tight fit. Everything has to adjust to it. But the body has a way.
It is done now. The journey ahead is about recovery now. It is a great feeling to be on the other side of the summit.
The room I am in is beautiful. It isn’t over the top. But it has its own prvate balcony to the outside. The sun is shining. Guadalajara is beautiful in September. A little humid but the afternoon rains are gorgeous. The nursing staff are wonderful, patient, caring and happy. It is the Mexican culture of caring. “La Familia” - -The Family. You have been welcomed into their extended family and they are caring for you like they would care for their own mother or father.
I have never witnessed this level of care before. It isn’t that you wouldn’t get that in western cultures but you get a share of the nursing staff’s emotional resources. These hospitals are not built to meet some Fortune 500 shareholder’s profit expectations. They don’t “scale” to meet some cost accountant’s budgets. They just provide care. Care is enough.
You are never abandoned. I never waited more than one minute for a nurse to attend to anything I needed. The food was fresh, clean and healthy. I was only in hospital for two nights but it was incredible. I’ve been in a lot of hospitals in my life. This was truly the best I have ever experienced.
My doctor is visiting me daily in hospital. He explains more about the procedure, checks my staples, even presents me the pins they pulled out of me as a souveneir. I talk more with him to learn so much of an “inside look” at the Mexican industry. He tells me that in Mexico they have more flexibility to do procedures and be doctors than in other countries. They take a hybrid model of best practices from the USA and Europe. They are not afraid to do what is medically necessary for their patient.
I realized a few things in hospital. Over the years I have had to design and write computer software for the medical industry in the USA. One thing I had to produce was a thing called a HCFA form. It was comical to see that the US medical administrative industry was 20 years behind other industries in terms of technological prowess. They still produce these forms on dot matrix printers in some cases. But I never really put 2 and 2 together with this.
The HCFA form shows what services, devices and pharmaceutical drugs are provided to patients. This is mainly for insurance claims. The patient details are stated, what is done and everything is coded. Like human life and doctor choice must fit into a pre-defined database. This is often because different insurance companies have pre-defined price schedules for these line items. The services are provided and then some artificial intelligence scans the form to determine if the patient is covered, or if what was provided was medically necessary. If the computer allows it, the insurance company will pay up to the pre-negotiated rate with the hospital or physician. The computer is the first triage of decision of financial liability.
Doctors often have to become experts with how to code their services to get it through the computer. This is not what the vast majority of physicians thought that being a practicing physician was going to be in college. Saving and improving patient lives was the goal. They would hire staff for these administrative tasks. Yet the patient gets stuck with this. Their deductibles must first be satisfied. The patient must have the right insurance. The physician must be in the right network. The drugs must be covered. The procedure must be coded correctly. How anyone can know all of this to get it paid is amazing. Oh I know... Only offer “standard” procedures even though something more complex is really needed. And therein lies the root cause of why I could not get treatment.
When it came to discharge at the hospital, we were taken over to the finance department to watch the computer spit out about eight pages of charges. I’m thinking that this is where I realize I got scammed. I was quoted approximately US $9,000 for all of this. I dug in every cushion of every couch to come up with the money. Is this going to be some massive number?
Then you see it. $76,607. Oh crap. The US system was going to be $126,000 for this. Some massive savings. Then you realize that is in Pesos. The USD equivalent is USD $3,800 based on the exchange rate at the time. And I already paid $1,250 of that. This doesn’t feel so bad afterall.
But this is only the hospital charges. I still have to pay for the surgical team and the prosthetic.
Two days later, we are scheduled to visit the doctor at his consulting rooms. Things look good. He surveys the wound, checks it over for nerve damage - none. Checks range of motion. Checks inflammation. Checks how the antibiotics are doing. Asks me about pain.
Surprisingly I have not had a lot of pain. They prescribed Tramadol for pain. I checked what this was and it is an opioid. But the Mexican government have strict rules on opioid prescriptions. This seems to be the lesser of all evils. However I haven’t needed them. Since leaving the hospital I took one to help me sleep on the first night but that is it.
Side note: When I was discussing doing this in some comment thread on YouTube the local trolls would rise up from under the bridge, spewing thieir hatred and FUD (Fear uncertainty and doubt) and I specifically remember someone trolling abpout how Mexico doesn’t prescribe opioids and that pain management will be poor compared to the USA. I guess they wanted to perpetuate the myth that the USA was #1 in pain management. Don’t get me wrong - I’ll give credit where credit is due, but would it not be a better solution to actually get treatment and remedy for an ailment rather than fall prey to over prescription to addictive narcotics?
Anyway back to the doctor’s office. He explains physical therapy regime going forward. And he schedules me for another follow up in a week’s time.
Then it comes time for the final bill.
I’m standing at the desk of his administrative assistant, VISA card in hand. Bracing myself for the cost. Finally the totals come. $44,000.00 for the prosthetic. $70,000.00 for the surgical team. MX $114,000.00 which works out to USD $5,700.00.
The doctor does warn me that he is closely monitoring how my tendons & muscles are repairing and recovering. He warned that a subsequent procedure may be necessary but he cannot know that for some time. They don’t tell you anything but the hard truth, which I truly appreciate. I’m doing everything in my power to follow physical therapy regime to the letter and so far each day is better than the prior one.
I’ll put aside some of the airfares because they were all paid with frequent flyer points. Hotel stay was also covered with points. I’ve provided the following table of costs to show what I’ve paid so far. All with cash. No insurance subsidies, etc. But here is the final cost schedule....
That is the question. I tried to find this out and spent a very large amount of time in search of the numbers. I’m excluded from insurance coverage so I can’t get any protection from pre-negotiated rates. It seems that about US $35,000.00 is about the right number as an estimate with insurance. There are so many variables though. When I tried to get “cash price” for this, I heard numbers north of USD $125,000.00 since I don’t have any power to negotiate the price. The hospital component is the scariest part of this.
The problem is what if they can’t cover you? What if they can’t code this to get it paid? What if things get messy? What about the risk of some adverse event? What about subsequent surgeries? What about physical therapist costs?
I feel safer here in Mexico than in the USA for so many reasons. That might seem shocking to many. But consider the experience so far...
The quality of training for surgeons is excellent. The willingness to do what is needed and not what fits some sort of computer database because of reimbusement is critical to getting the outcome required. English is routinely spoken within the medical professionals I dealt with. Services that may be excluded, particularly pre-operative like MRIs, due to cost, can make the world of difference.
The hospitals are ther best I have ever experienced in the world. That said my experiences have been in Australia and USA, but there isn’t that frantic, mistake prone, high stress workloads in Mexico. And when you need total focus, this is where I would choose to have surgery and post-operative recovery.
And finally the costs. In a conversation with my doctor, he mentioned that on average his experience showed that Mexican costs were about 1/8th of the equivalent price in US medical services. My own experiences have shown that the true ratio for my services was closer to 1/10th of the US pricing.
Money shouldn't be a factor in life & death decisions. But the reality is that in the USA we just can't afford healthcare anymore. For the many of us that have limited budgets or may not have a third party to pay for their care should realize that we do have choices. Medical bankruptcy should never be a thing. A free market for healthcare self-cleans the economics. Providers must offer a competitive product for a fair price. We clearly don't have this in the USA and people suffer because they follow the herd over the cliff to bankruptcy when there is often a better option.
Being treated like you are part of someone else’s family was huge to me. I was never treated like a number or a piece of inventory. I was truly cared for. By people that don’t know me, don’t speak my native language and have every reason to feel disrespected by international politics. Yet when it came to their skills and duty as medical practitioners, they were incredible. I owe a debt of gratitude to the medical team and my doctors. I owe a debt of gratitude to Mexico for so many things, but this one seals the deal.
I have to compare compaassion here and from my experiences, Mexico wins.
I do not want, in anyway, to degrade the quality of healthcare in the USA or Australia that any of my readers may have experienced. What doctors do is amazing to me - saving lives and increasing patient life quality is the ultimate service to humanity. I hold doctors as the beacons of what we humans can aspire to. And for all of us that have great outcomes and are indebted to medical professionals, I want you to know that my experiences are my own. I congratulate and celebrate your outcomes as I do my own. My experiences and methods don’t represent the majority - they parallel my life’s following of contrarianism and the unconstrained lifestyle.
As the great Andrew Henderson of Nomad Capitalist says, “Go where you are treated best”
The following is provided if you wish to follow down my path:
It can be a frightening thing - choosing to go to a foreign country to get major surgery. The vast majority of us find that a bridge too far to cross. I took the leap of faith, and I have begun the journey. This article (and hopefully the one that will follow it after my surgery is completed) will give a totally fact based account of the experience so you can see if something like this makes sense for you.
We should all take the best care of our teeth. But in the USA, costs are outrageous. Insurance doesn't cover most dental procedures and patients are often presented with $10K+ bills for basic dental work. If they realized there was a better option right on their doorstep, this could all be avoided. Welcome to medical tourism, and the border town of Los Algodones, Mexico.
US Medical costs are out of control. But rather than dealing with that, voters will be faced with political policy decisions based on whether the govt should pay for it.
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