Why You Don’t Need to Pay Out of Pocket for Endometriosis Care

Cash-based endo care

Paul J. MacKoul, M.D., co-founder, The Center for Innovative GYN Care

If you have endometriosis, you know it may only be a matter of time before it becomes necessary to find a surgeon to remove it. At any of its four stages, endometriosis can cause severe pelvic pain and heavy bleeding, which often interferes with daily activities. It can be difficult to diagnose because lesions can only be identified through laparoscopic surgery, meaning you need to find a qualified GYN surgeon.

The search for an endometriosis specialist can be especially difficult due to the nature of the endometriosis industry and the condition’s complex financial burden. Insurance becomes a hot topic quickly, because the out-of-pocket expenses can be sky high if insurance is not accepted. Many providers will not accept insurance for your procedure. But before you book your procedure, here’s why you should hesitate when asked to pay for your surgery up front.

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Endometriosis as a ‘Pay to Play’ Industry

Treatment for endometriosis in the United States has become its own industry within health care. Whether a surgeon is spending five hours excising endometriosis lesions or 30 minutes burning them away with ablation, both surgeries use the same code for insurance purposes (though excision has much better outcomes). Both surgeons will get paid the same amount by insurance providers regardless of their experience level. This moves many endometriosis surgeons to sever their in-network ties with insurance companies. As out-of-network or “cash-only” providers, these surgeons are now able to set their own prices. But great endometriosis care shouldn’t be just about what the surgeon can bill to insurance — it’s about the patient.

Everyone deserves access to a pain-free life, and finances should never be a barrier to getting the treatment you need to achieve it. We work with most major insurance carriers and are always looking for ways we can participate in additional plans. Nothing should stand in the way of the endometriosis care you need.

The “cash-only” model of the endometriosis industry makes expert treatment exclusive to those who can afford to pay out of pocket. Some surgeons set their fees at $10,000 or more and then tell their patients to ask their insurance provider for a reimbursement, which rarely materializes. A large portion of the population that needs endometriosis surgery is now excluded by high out-of-pocket costs.

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Cash Won’t Buy You the Best Outcome

The Center for Innovative GYN Care is one of the few endometriosis treatment centers that continues to stay in network with major insurance providers. And with our specialists’ expertise and low complication rates, it’s not necessary to pay out of pocket for the best possible outcome. At CIGC, our fellowship- and oncology-trained surgeons use only a few small incisions to excise endometriosis lesions using a trademarked technique called DualPortGYN. This technique allows the surgeons to have as much visibility of the entire pelvic area as they would in an open abdominal procedure — without needing a 6- to 8-inch incision.

Because endometriosis typically affects organs that are often involved in GYN cancer cases, our surgeons are trained in the same techniques a GYN oncologist uses. Surgeons without training in oncology procedures may need to bring in an expert for more complex cases of endometriosis, but our surgeons have performed thousands of minimally invasive excision surgeries without the assistance of a general surgeon or robotics. They can perform endometriosis excision at all stages of disease faster and more effectively than OBGYNs or surgeons without extensive pelvic surgery training.

 Breaking Down the Barriers of Endometriosis Treatment

Endometriosis can be extremely painful, and adding additional financial stress to a patient with an already difficult condition is not necessary. At CIGC, our patient advocacy team will work with you to use your health care benefits to their fullest potential. They will contact your insurance provider to confirm your plan has participating benefits, help you calculate any out-of-pocket costs and file any necessary paperwork on your behalf.

Everyone deserves access to a pain-free life, and finances should never be a barrier to getting the treatment you need to achieve it. We work with most major insurance carriers and are always looking for ways we can participate in additional plans. Nothing should stand in the way of the endometriosis care you need.

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CIGC is dedicated to providing information and materials for women to help navigate the complicated health care system. The CIGC founders, minimally invasive GYN surgical specialists Paul MacKoul, MD, and Natalya Danilyants, MD, developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind.

Their personalized approach to care helps patients gain a better understanding of their condition and the recommended treatment so they can have confidence from the very start. Our surgeons have performed more than 25,000 GYN procedures and are constantly finding better ways to improve outcomes for patients.

Our patient advocacy team helps patients get the most out of their health insurance. They will contact your health insurance provider to confirm your plan has participating benefits, calculate your out-of-pocket costs and file any necessary paperwork with your insurance provider on your behalf.

At CIGC, we take the guesswork out of the process so you can focus on what’s most important: finding relief and getting back to your life.

 

About the Author

Dr. Paul J. MacKoul, minimally invasive GYN surgeon

Paul J. MacKoul, M.D.
Dr. Paul J. MacKoul, co-founder of The Center for Innovative GYN Care, is fellowship-trained in GYN oncology and specializes exclusively in minimally invasive GYN surgery. He co-developed the advanced laparoscopic techniques DualPortGYN® and LAAM® with Natalya Danilyants, M.D.; both procedures have unmatched outcomes compared to other methods of minimally invasive GYN surgery.

Dr. MacKoul, who is also CEO of the GYN ASC management company Tower Surgical Partners, graduated from medical school at Tufts University, then completed his residency in OBGYN at the University of Maryland. His fellowship in gynecologic oncology was at the University of North Carolina.

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Feature photo by Omid Armin on Unsplash