Starting Care at Lotus

Steven Vasilev, MD, PC is out of network with all insurance plans and does not maintain ongoing contractual relationships with insurers. Patients are often advised by insurance call centers that out-of-network care is not covered or is automatically cost-prohibitive. Such guidance typically reflects standardized benefit scripts and may not distinguish between routine specialty services and highly specialized, quaternary-level care that is not widely available within insurance networks. As a result, initial insurer responses may not fully reflect how benefits are ultimately applied in complex or uncommon clinical situations.

We work with a specialized, external patient advocacy partner to assist patients in understanding and, when appropriate, pursuing insurance-based options that may apply in complex cases. This can include formal review or dispute processes that are not typically visible during routine insurer calls. Coverage is never guaranteed, timelines vary, and transparency and realism are essential.

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. 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.

Our Approach: Minimizing Financial Toxicity

We recognize that chronic pelvic pain and complex endometriosis can already be financially exhausting. Missed work, repeated imaging, medications, emergency visits, and prior surgeries add up long before a patient reaches our door.

For the vast majority of patients, we do not require deposits or prepayment to begin care. When surgery is being considered, our team helps patients clarify the practical items that matter most: whether the planned hospital or facility is in network for your plan, what documentation is needed for scheduling, and what authorization requirements apply, if any.

A note about common models in this space: Some patients exploring complex endometriosis care encounter programs that require large cash payments up front — often tens of thousands of dollars — followed by an unassisted "superbill" submission process. Patients should understand that upfront cash payment to a surgeon does not automatically guarantee reimbursement, and reimbursement outcomes can vary widely depending on the plan.

Our model is very different. We focus on evidence-based care and clarity, and we aim to minimize administrative and financial burden wherever possible.

Payment Pathways & Cash-Pay Situations

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.

***Important note: This information is general and does not constitute legal, financial, or insurance advice. Coverage and patient responsibility depend on the specific plan and clinical circumstances.

We are intentionally cautious about encouraging large upfront cash payments.

In many cases, pursuing insurance-supported pathways may ultimately result in lower overall patient responsibility. For this reason, our team first evaluates all reasonable insurance options before recommending a cash-pay pathway.

All care — regardless of payment source — proceeds only within a clearly defined and reviewed financial structure.

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.

At the same time, care provided through Lotus Endometriosis Institute reflects a narrow, highly specialized level of expertise based on advanced surgical training, cumulative experience, and the complexity of cases managed. This level of care is not widely available within standard specialty practice or typical insurance networks.

Accordingly, all treatment is delivered within a transparent, predefined clinical and financial framework, reviewed in advance so patients can make fully informed decisions before proceeding.