Insurance, Cost, & Financial Transparency
Clear answers on cost, insurance, and payment — before you commit to anything.
Helping you navigate the logistics
How Billing & Insurance Work at Lotus
Below is an explanation of how insurance, cost, and payment work when receiving care through our practice — including what to expect being out of network, how we approach financial clarity, and what options are available to you. If "out of network" immediately feels like a dealbreaker, you're not alone — but the reality is usually far less daunting than that first reaction suggests, and our process is designed to work in your favor. Our goal is to make sure you understand the financial side of care before committing to anything.
Care associated with the Lotus Endometriosis Institute is provided through Steven Vasilev, MD, PC, a California professional corporation. "Lotus Endometriosis Institute" refers to the specialized clinical program and care model developed by Dr. Vasilev and his team. All medical services, billing, and regulatory compliance are handled through Steven Vasilev, MD, PC in accordance with California and applicable federal requirements.
Helping you navigate the practical details
Out-of-Network Care
Steven Vasilev, MD, PC is out of network with all insurance plans and does not maintain ongoing contractual relationships with insurers. If you've called your insurance company and been told that out-of-network care isn't covered — or that it will be prohibitively expensive — that response is worth understanding in context.
Insurance call centers typically work from standardized benefit scripts designed around routine specialty care. Those scripts don't always distinguish between a standard office visit and highly specialized, quaternary-level surgery that simply isn't available within most insurance networks. Because of this, the initial answer you receive from your insurer may not fully reflect how your benefits are ultimately applied — particularly in complex or uncommon clinical situations like advanced endometriosis.
Making it Work
Patient Advocacy Support
Navigating insurance in these situations can be confusing and discouraging, which is why we work with a specialized, external patient advocacy partner. Their role is to help patients understand the insurance-based options that may apply to their case and, when appropriate, pursue formal review or dispute processes that aren't typically surfaced during routine insurer calls.
Coverage is never guaranteed and timelines vary. But having someone in your corner who understands how these processes work can make a meaningful difference. Transparency and realism guide every step of this process.
Cost Clarity
What Will This Actually Cost Me?
This is one of the most common concerns we hear — and one of the most important to address clearly.
In almost all cases, surgery is performed at an in-network hospital or facility. That means your expected out-of-pocket responsibility is typically limited to your in-network deductible, copay, and/or coinsurance, subject to your specific plan's benefits.
The biggest misconception we see: that choosing an in-network surgeon automatically means a lower bill. It doesn't. In reality, the key financial variable for most patients is their deductible and coinsurance — not whether a surgeon is listed as in-network. And choosing a less-experienced surgeon can end up costing far more in the long run.
A practical way to think about cost: Most insurance plans include some form of patient cost-sharing — a deductible, copay, and/or coinsurance. The exact amount depends on your plan's benefit design. When surgery is performed at an in-network facility, patient responsibility is often limited to in-network cost-sharing, subject to plan terms and applicable protections.
Understanding how payment works at every step
Payment Options & Financial Structure
Every patient's financial situation is different, and so is every insurance plan. The sections below explain how we handle payment pathways, health sharing plans, and our overall approach to keeping care financially transparent and accessible.
Payment Pathways
In most cases, our team works directly with your insurance provider to secure a Single Case Agreement (SCA), GAP exception, or authorization — primarily when out-of-network benefits are available. Our team advocates on your behalf in many cases even without OON benefits, though securing an agreement is harder in those situations.
If you do not have out-of-network benefits — or if an agreement cannot be secured even after appeal — surgery may proceed on a pre-operative cash-pay basis. In those situations, a personalized Good Faith Estimate (GFE) is provided, all professional fees are paid in full prior to surgery, and we do not balance bill patients after the fact. Third-party medical financing options may also be available.
Our goal is full financial clarity before surgery — never surprise billing afterward.
Health Sharing Plans
Certain health-sharing plans (such as Medi-Share) operate differently from traditional insurance. These plans may require up-front patient payment, submission of a Good Faith Estimate, and direct reimbursement requests made by the patient.
This structure is defined by the sharing entity — not by Lotus Endometriosis Institute or Steven Vasilev, MD, PC. Our team provides the documentation required by your sharing plan directly to you.
Our Philosophy on Cost & Payment
We are intentionally cautious about encouraging large upfront cash payments. In many cases, pursuing insurance-supported pathways results in lower overall patient responsibility, which is why our team exhausts those options before recommending a cash-pay pathway.
Our goal is to help patients pursue medically appropriate care without unnecessary financial toxicity. Clinical recommendations are based on medical judgment and long-term outcomes — not on a patient's ability or willingness to enter into any particular financial arrangement. All care — regardless of payment source — proceeds only within a clearly defined and reviewed financial structure.
The care provided through Lotus Endometriosis Institute reflects a narrow, highly specialized level of expertise — built on advanced surgical training, cumulative experience, and the complexity of cases managed — that is not widely available within standard specialty practice or typical insurance networks. This is precisely why the financial structure is defined clearly and reviewed in advance, so patients can make fully informed decisions before proceeding.