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Dr. Lora Liu, Endometriosis Excision Specialist, New York City

Out-of-Network Rationale

Out-of-Network Rationale

Dr. Liu and Endometriosis and Advanced Pelvic Surgery are out-of-network with health insurance networks, which means that we do not have contractual agreements with any insurance company. Typically, the insurance company sets the fees, and health care providers must accept these fees, regardless of the complexity of the case and the expertise needed. This incentivizes the health provider to treat more patients and to do more procedures on them, whether or not this is in the patient’s best interest. Such a system of practicing medicine can result in compromising quality over economics.

For example, a general OBGYN might perform a diagnostic laparoscopy to investigate suspected endometriosis and use cauterization or ablation techniques to “treat” small lesions, often completing the procedure in an hour or less. However, this approach is suboptimal for effectively treating endometriosis. While ablation is commonly taught in residencies and requires only average skills, numerous studies have demonstrated superior outcomes with excisional surgery. Unlike ablation, excision surgery is an extremely intricate and delicate procedure, requiring advanced skills which are only acquired after several years of dedicated training and subspecialization.

Furthermore, there is no financial motivation to switch from ablation to excision, as the surgeon receives the same payment, despite having to spend up to six or more hours, such as with Stage IV cases, in meticulously excising advanced stage endometriosis, such as rectal shaving, discoid bowel resections, ureterolysis, and/or ovarian cystectomies. Unfortunately, the insurance reimbursement is based upon Current Procedural Terminology (CPT) codes and there is only one CPT code that exists for laparoscopic surgery for endometriosis, regardless of whether excision or ablation is conducted. This means that whether a brief ablation surgery or an extensive excision surgery spanning several hours, the surgeon receives the same payment. 

This situation presents the in-network surgeon with two options: 1) perform a substandard surgery that may not provide long-term benefits to the patient, or 2) conduct the surgery without receiving sufficient financial compensation for their time or expertise. Because of this, most of the highly skilled endometriosis excision specialists are out-of-network due to the extensive effort, technical skills, and time required to execute a meticulous and comprehensive surgery. Having surgery performed by an endometriosis specialist, such as Dr. Liu, not only reduces the likelihood of future surgeries but also guarantees personalized care for patients with better outcomes.

Recognizing the substantial financial strain faced by many patients, Dr. Liu tailors her surgical plan to align with her patient’s unique medical history, needs, and goals. Additionally, our policy ensures full transparency by providing patients with upfront information regarding their surgical fees, with no surprise charges or balance billing. This commitment extends to patients utilizing out-of-network insurance benefits or those who self-pay, as we aim to minimize the financial impact on those seeking top-tier endometriosis surgical care.

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