Connecting with a high volume excision surgeon who was truly trained in the accurate detection of endometriosis was like a dream come true for me as an endometriosis patient who had gone 31 years without a diagnosis. This doctor was aware of all of my symptoms, acknowledged and validated my experience, knew how to do the only type of surgery capable of removing the lesions and, most importantly, bolstered my confidence in myself and my symptoms. The sensation of having a doctor sit across from you, look you in the eyes, and tell you that he feels you have endometriosis is nearly as soothing as the procedure itself.
I scheduled my operation soon after, despite having no idea how I was going to pay for it. I ended up filing a claim with my insurer, who covered the entire cost, and now I teach women how to do what I did as part of my advocacy work. Here are some of the things I discovered along the road.
Endometriosis patients are stuck in a “care gap” or “access to care gap,” as it’s known in the medical sector. This means that most insurance do not cover the surgeon’s labor fees for excision surgery. The factors that contribute to this “care gap” are numerous.
- Endometriosis removal via fulguration, ablation, coagulation, and excision were all lumped together in a 1992 Medicare Part B judgement.
- Medicare tables are used by all insurers to determine how much they will reimburse. Because of the aforementioned, there is no code for excision surgery in these tables.
- The American Medical Association does not designate excision as a specialty (AMA). There are no standard certifications or boards.
- Even if hundreds of clinical, peer-reviewed articles state otherwise, the American Congress of Obstetricians and Gynecologists (ACOG) does not acknowledge excision as a speciality or as the gold standard of surgical therapy for endometriosis.
- Excision and diagnosis of endometriosis are not taught in medical schools since doctors can’t earn a career practicing it unless they work at a prominent university.
- Doctors are protected under the “standard of care.” This medical word basically indicates that if the type of treatment you’re giving your patients is similar to what your peers are giving, you’re safe from liability. Even when hormonal medications, such as the pill, have been found to be palliative at best and harmful at worst for many women, as in the instance of endometriosis.
I’m describing these methods because endometriosis sufferers must understand that they’re dealing with major structural concerns over which they have no control. This is crucial to remember when filing your appeal for your own sanity.
As we all know, all of the foregoing is a nightmare for patients. Because surgeons are not paid by insurance companies, they must either work at a university or accept direct payment from patients. Patients don’t always have access to a university-based surgeon. Meanwhile, as an endo patient, getting trapped in this “care gap” means your symptoms will increase while you try to find out how to pay for the surgery.
So, what to do?
The most important thing to remember when approaching your insurance is that their business model is built on the assumption that patients will give up. The key is to never give up!
You must mount your case six to eight weeks prior to surgery (even though many women have appealed post-surgery and gotten reimbursed for some or all of their expenses). Pre-surgical appeals provide you the opportunity for a peer-to-peer review with your surgeon and insurance, which can be critical in getting your operation covered.
Next, you’ll want to make sure that if your insurer agrees to pay your surgeon in-network prices, your surgeon is willing to take them. In most situations, in-network fees will be pennies on the dollar due to coding issues and non-recognition of the speciality. So, if your insurer says “yes, we’ll pay in-network,” you should confirm with them exactly how much they’ll pay before surgery, and run that information by your surgeon to be sure they’ll accept those rates. If they are, obtain written confirmation from your insurer prior to surgery.
In the best-case situation, you should request a Single Case Rate. This is where your surgeon and insurer talk over the phone to work out a reasonable price for this extremely difficult surgery. With a Letter of Agreement, you certify that this rate has been accepted, and this is your contract requiring the insurer to pay the surgeon. This is the best case situation since surgeons are compensated fairly and you, the patient, are not responsible for the medically essential care you require. You may be charged a deductible or co-insurance, but it will be on an in-network basis, which is usually far less expensive. A Single Case Rate appeal follows the same criteria as a Medicare or Tricare appeal. The procedure and who you contact may differ, but the clinical evidence you provide and the manner in which you provide it are the same.
The importance of persistence and follow-up cannot be overstated. Contact your insurance, request a Single Case Rate, enlist the help of your surgeon’s office, have clinical data concerning excision on hand (letters from your surgeon, primary care physician, etc.) and be ready to support your case. Then phone, email, and harass them! You have the ability to succeed.
How much does it cost to have surgery for endometriosis?
With endometriosis, the average monthly direct costs per patient are: $1730.72 1 year after diagnosis, $758.09 2 years after diagnosis The cost of a surgical operation varies, ranging from $14,564.73 for a vaginal hysterectomy to $26,002 for a total hysterectomy (other peritoneal adhesiolysis). $21,268.26 for laparoscopy.
Is laparoscopy for endometriosis covered by insurance?
- Laparoscopy can cost anywhere from $1,700 to $5,000, depending on the doctor and if the procedure is performed to diagnose or treat a problem. Endometriosis, ovarian cysts, scar tissue, and blocked or damaged fallopian tubes can all be treated via laparoscopy.
- Laparoscopy is generally covered by health insurance because it is a diagnostic test that is also used to treat health conditions, such as endometriosis, that might have an impact on a patient’s overall health. It is, however, critical to double-check with the insurance.
- Insurance coverage for infertility treatment is required in some states, with some exceptions. States that require coverage are listed by the American Society for Reproductive Medicine.
- Out-of-pocket costs for individuals with insurance can go into the hundreds of dollars or even thousands of dollars, depending on whether they have copays for doctor visits or a portion of the treatment reimbursed; some plans only cover 50 to 80 percent.
- To inspect the uterus, fallopian tubes, and ovaries, the doctor makes a small incision in the abdomen and inserts a telescope-like instrument. If scar tissue or other problems are discovered during the diagnostic procedure, they can easily be rectified by connecting surgical instruments to the scope.
- An summary of laparoscopic surgery can be found at the Advanced Fertility Center of Chicago.
- Patients who pay for reproductive tests and treatment out of pocket may be eligible for monetary discounts at some clinics.
- The doctor you choose should be an American College of Obstetricians and Gynecologists board-certified obstetrician and gynecologist with training and expertise conducting laparoscopy.
Is it worth getting endometriosis surgery?
Surgery, like hormone therapy, resolves endometriosis discomfort in the majority of women. However, it does not ensure long-term results. According to some studies, the majority of womenroughly 60 to 80 out of 100experience pain reduction in the first few months after surgery.
Can you request endometriosis surgery?
Endometriosis is not curable, however it can be managed by medication or surgery. Pain medicines may be enough to help if your symptoms aren’t too severe. If you don’t want to get pregnant right now, your doctor or nurse can recommend hormonal birth control (such as the pill or a hormonal IUD) to reduce pain and bleeding. If you’re attempting to conceive, there are alternative endometriosis drugs you can use.
If your endometriosis symptoms are severe or you have been unable to conceive, surgery for endometriosis may be a possibility for you. The growths outside of your uterus will be removed by a surgeon, reducing pain and making it simpler for you to become pregnant. However, because the growths frequently reappear after surgery, you may need to take additional medicine. Some women have a hysterectomy as a last resort, which involves removing the uterus and sometimes the ovaries, however it is difficult to conceive thereafter.
How is endometriosis removed?
Endometriosis can be treated as soon as it is discovered. Laparoscopy is a surgical procedure used to diagnose endometriosis. Endometrial lesions (endometrial tissue implants outside the endometrium) can be cut away (excised) or burned away with a high-energy heat source like a laser (ablated). Advanced illness involving extensive sections of the rectum or bigger lesions makes laparoscopic treatment more difficult.
How are endometriomas treated?
Simple puncture: The fluid from the cyst is drained at the end of the surgery. More than half of individuals with endometriomas who were treated with simple puncture had them return. A more severe surgical technique, such as removing the lump, can result in substantial adhesions (scar tissue) that inhibit the ovary from releasing an egg. As a result, experience is essential to avoid harm.
Draining the cyst and removing the cyst’s base with laser or electrosurgery is another option. Heat, on the other hand, can harm the ovary.
Cutting the cyst wall away is the preferred technique for reducing disease recurrence. This operation can potentially harm the ovary’s outer layer, which stores the eggs.
Drainage, medication, and surgery: Endometriomas can be drained, treated with medicine, and then surgically removed.
Pregnancy rates of 50% over three years have been observed in various different prospective studies. There are no randomized clinical trials that compare the various therapy options.
How is advanced endometriosis treated?
The care of severe endometriosis within the pelvic cavity, rectum, and vagina is the most difficult operation by laparoscopy or laparotomy (conventional abdominal surgery, which requires a wider incision). Several studies have found that 50 percent to 60 percent of cases treated with surgery result in pregnancy after two years. Endometriosis may return in 20% of instances, according to various studies.
Does endometriosis surgery leave scars?
Endometriosis is a condition in which the uterine endometrial glands and stromal component are visible outside the uterine cavity in women of reproductive age. Endometriosis in a surgical scar is a very uncommon complication following obstetric and gynecologic procedures. Scar endometriosis is characterized by cyclic pain and a growing tumor in the scar following obstetric or gynecologic procedures. We report 24 examples of scar endometriosis, with a focus on variations of clinical symptoms, differential diagnosis, treatment approaches, and prevention.
How long is recovery from endometriosis surgery?
What to expect after endometriosis surgery and how long it takes to recover Quick recovery within 3-4 days. Within 7-10 days, you should be able to exercise and have sexual relations, and you should be off work for one week. By 4-8 weeks, you should be fully recovered. Fertility returns within 4-8 weeks post surgery.
Is laparoscopy more expensive than open surgery?
1. WHAT IS LAPAROSCOPIC SURGERY AND HOW DOES IT WORK?
The operation is known as laparoscopic surgery because it is performed with the use of a laparoscope, which is a rigid camera scope coupled to a light source and video processing unit that allows surgeons to see into the patient’s body directly. Using fine specialized devices and dexterous manipulation, surgeons are able to diagnose and treat disease.
Because only very small incisions are used, laparoscopic surgery is also known as keyhole surgery.
2. WHAT MAKES IT DIFFERENT FROM REGULAR OPEN SURGERY?
We can find various advantages in laparoscopic surgery that can greatly assist the patient.
In Laparoscopic Cholecystectomy, or the removal of the gallbladder, for example, small skin incisions of about 5-10mm are used instead of a major skin incision to open up the belly. Furthermore, because the same procedure is performed with less physical damage, a patient can expect much less pain and a shorter hospital stay, resulting in an earlier return to work and normal activities.
3. IS IT AN EXTREMELY PAINFUL EXPERIENCE?
Laparoscopic surgery has the advantage of causing less pain and causing less tissue damage than traditional open surgery.
In open surgery, a large incision is required, however in laparoscopic surgery, the process can be performed with three or four ports, or even a single port, referred to as “single incision Laparoscopic Surgery” by surgeons.
4. WHAT IS THE DURATION OF MY STAY IN THE HOSPITAL?
A shorter hospital stay is one of the advantages of laparoscopic surgery versus traditional surgery.
The patient’s hospital stay can be as short as one day depending on the type of laparoscopic surgery performed. In fact, most of our patients who have a laparoscopic cholecystectomy or hernia repair can stand, walk, and return home the next day.
5. HOW SOON CAN I RECOVER AND RETURN TO NORMAL LIFE AFTER LAPAROSCOPIC SURGERY AFTER BEING DISCHARGED FROM THE HOSPITAL?
Studies have shown that individuals who have laparoscopic surgery return to work much sooner. There is less tissue manipulation and the internal organs can recover to normal functioning considerably faster thanks to the use of delicate devices and precise movements.
Due to the fact that this is still surgery, the body will require a few days to recover from the physiologic stress. So, depending on the type of surgery performed, full recuperation could take anywhere from a few days to one or two weeks.
6. DOES IT COST MORE THAN OPEN SURGERY?
Laparoscopic surgery is cost-effective because to its several advantages, including a quicker return to work when compared to traditional open surgery, which might take weeks to recover from. The loss of income is smaller with laparoscopic surgery, and it is more advantageous for people who want to keep an active lifestyle.
7. CAN LAPAROSCOPIC SURGERY BE DONE DURING THE COVID PANDEMIC?
The surgical community initially ceased doing elective procedures due to concerns about virus transmission through surgical smoke and aerosolized particles inside the belly during Laparoscopic Surgery.
To date, however, there has been no indication that this raises the likelihood of viral transmission.
Furthermore, during earlier viral epidemics, evidence from comparable viruses such as, and), has not indicated disease transmission from Laparoscopic Surgery.
In fact, compared to open surgery, where the abdominal contents are exposed, the surgical plume and aerosolized particles are easier to contain because we are working in a restricted space.
We can now further reduce the risk of presumed viral contamination by using additional mitigating measures such as mandatory RT-PCR Swab testing prior to surgery, smoke evacuators, performing surgery in a negative pressure operating room, and doctors, nurses, and hospital staff wearing appropriate PPEs.
8. WHAT LAPAROSCOPICAL PROCEDURES ARE AVAILABLE?
IS HEALTH INSURANCE COVERED FOR LAPAROSCOPIC SURGERY?
Because laparoscopic surgery is still considered surgery, health insurance coverage is available for these treatments.
You can find out about your health insurance company’s surgical benefits by contacting them.
DO ALL SURGEONS HAVE THE ABILITY TO PERFORM LAPAROSCOPIC SURGERY?
The majority of surgeons can now safely perform Laparoscopic Cholecystectomy, however the success of each treatment is highly dependent on the surgeon’s abilities, expertise with Laparoscopic Surgeries, and the hospital’s equipment. Other specific or sophisticated operations necessitate a high level of competence and experience from the surgeon, therefore it’s advisable to discuss it with your surgeon.
11. HOW DO I SCHEDULE A CONSULTATION?
How much does a diagnostic laparoscopy cost?
What Is the Cost of a Diagnostic Laparoscopy? A Diagnostic Laparoscopy costs between $7,144 and $10,078 on MDsave. Those with high deductible health plans or those who do not have insurance might save money by purchasing their procedure in advance with MDsave.
What does Stage 4 endometriosis mean?
Endometriosis in Stage IV is the most severe stage, with scores generally exceeding 40. 13 A considerable number of cysts and severe adhesions are found at this stage. While some cysts will go away on their own, cysts caused by endometriosis will almost always need to be surgically removed.