July 15, 2020 | by Tamer Seckin, MD
Summary
The Seckin Endometriosis Center provides detailed information regarding its insurance coverage and out-of-pocket costs for surgical treatment of endometriosis. As an out-of-network provider, SEC works with most major insurance companies, although it does not participate with Medicare, Medicaid, or Tricare. Patients are encouraged to discuss their insurance benefits with the surgical coordinator to understand potential coverage options.
Treatment costs vary with the services provided and the severity of the condition, and final expenses may be influenced by the patient’s insurance plan. For those without out-of-network coverage, self-pay options and financing solutions are available.
Endometriosis surgery insurance coverage can be confusing, especially when you are already managing pain, appointments, and decisions about your care. At Seckin Endometriosis Center (SEC), we want to make the insurance and financial process as clear and straightforward as possible before you move forward with surgery.
Our team works with patients from New York, across the United States, and internationally. Because every insurance plan is different, coverage for endometriosis surgery depends on your individual policy, benefits, deductible, and out-of-network coverage.
Is Endometriosis Surgery Covered by Insurance?
Insurance may cover some of the costs associated with endometriosis surgery, but the amount of coverage varies significantly by plan.
At Seckin Endometriosis Center, our practice is dedicated to the surgical treatment of endometriosis. SEC is an out-of-network surgical practice, and Dr. Tamer Seckin performs surgery exclusively at Lenox Hill Hospital in New York City.
If your insurance plan includes out-of-network benefits, your policy may provide reimbursement or coverage for a portion of SEC’s professional surgical fees. Your actual benefits will depend on the terms of your individual insurance plan.
Our team can help you understand the financial information related to the SEC’s surgical fees and the questions you may want to ask your insurance company before surgery.
What Does Endometriosis Surgery Insurance Cover?
When considering endometriosis surgery insurance, it is important to understand that surgery can incur charges from multiple providers.
The insurance and financial information provided by the SEC applies specifically to the professional surgical fees charged by Seckin Endometriosis Center.
Other charges associated with your surgery may be billed separately, including:
- Lenox Hill Hospital facility fees
- Anesthesia services
- Pathology and laboratory services
- Imaging or diagnostic testing
- Other physicians or healthcare professionals involved in your care
These providers bill independently and may have different relationships with your insurance company. A provider may be in-network even when SEC is out-of-network, or vice versa.
For this reason, patients should verify coverage for each component of their surgical care whenever possible.
Out-of-Network Endometriosis Surgery
SEC is an out-of-network surgical practice.
Being out-of-network does not necessarily mean that you have no insurance benefits. Some PPO and other insurance plans include out-of-network benefits that may contribute toward eligible surgical expenses.
Coverage can depend on factors such as:
- Your deductible
- Out-of-network deductible
- Coinsurance
- Out-of-pocket maximum
- Allowed amount determined by your insurance company
- Specific benefits and exclusions within your policy
Before making decisions about surgery, we encourage patients to speak directly with their insurance company to understand their individual benefits.
Lenox Hill Hospital Insurance Coverage
Dr. Seckin performs endometriosis surgery exclusively at Lenox Hill Hospital in New York City.
Lenox Hill Hospital accepts most insurance plans, excluding out-of-state Medicare and Medicaid plans.
Hospital insurance participation is separate from the SEC’s professional surgical fees. Patients should confirm their specific hospital coverage directly with their insurance provider and Lenox Hill Hospital.
Questions to Ask Your Insurance Company
When contacting your insurance company about endometriosis surgery insurance coverage, having the right questions ready can make the conversation easier.
Consider asking:
- Does my plan include out-of-network surgical benefits?
- What is my out-of-network deductible?
- How much of my deductible have I already met?
- What is my coinsurance after meeting the deductible?
- What is my out-of-pocket maximum?
- Is Lenox Hill Hospital in-network with my plan?
- Do I need prior authorization for surgery?
- Are anesthesia and pathology covered separately?
- What documentation is required before surgery?
Write down the representative’s name, the date of the call, and any reference or confirmation number provided during the conversation.
Understanding Endometriosis Surgery Costs
There is no single cost that applies to every endometriosis surgery.
Endometriosis can vary considerably from one patient to another. The complexity of surgery and the services required may depend on the location and extent of disease, as well as the individual surgical plan.
Your overall costs may also depend on your insurance benefits and the separate charges associated with the hospital and other providers.
Our goal is to provide as much clarity as possible regarding the SEC’s professional surgical fees before you proceed.
We’re Here to Help You Understand the Process
Navigating insurance should not add unnecessary uncertainty to an already important healthcare decision.
If you are considering endometriosis surgery with Dr. Seckin, our team can help explain SEC’s financial process and provide information that may help you communicate with your insurance company.
Because insurance policies and benefits vary, your insurance provider remains the best source for determining exactly what your individual plan will cover.
Please note that Lenox Hill Hospital accepts most insurance plans, excluding out-of-state Medicare and Medicaid plans.
FAQs
Is Seckin Endometriosis Center insurance-friendly?
Seckin Endometriosis Center is an out-of-network provider with all insurance companies. While we are insurance-friendly, we are not contracted with any insurance company. We bill patients’ insurance carriers, but our services are always processed as out-of-network. We will work with most major insurance companies if your plan includes out-of-network benefits. No matter your coverage, we encourage you to consider your health first. With certain HMO plans, you may be eligible for coverage, however, SEC cannot guarantee approval from your insurance carrier. It is always best to review financial options in-office with our surgical coordinator, who will assist you in initiating this process, if applicable.
Please note that we do not currently participate with Medicare, Medicaid, Tricare, or Medicaid-sponsored plans.
Why does Seckin Endometriosis Center remain an out-of-network provider?
While insurance companies lower out-of-pocket costs, in-network providers often have limited decision-making capabilities, ultimately affecting the quality of patient care. To avoid such limitations, we choose to remain an out-of-network provider. As such, we are able to maintain our autonomy and ensure our patients receive optimal care catered to their individual cases.
How much does treatment at Seckin Endometriosis Center cost?
Our treatment fees vary depending on the services you receive and the severity of your condition. Your insurance provider and plan may also affect the final cost of your surgery. We cannot determine treatment fees until we understand the extent of endometriosis at the time of surgery.
How can I check my insurance benefits with Seckin Endometriosis Center?
You may determine your insurance benefits and coverage over the phone with a new patient coordinator. By providing all necessary information, we can check your benefits free of charge. Alternatively, you may call your insurance carrier to discuss your plan directly before providing us with your insurance information.
What if I do not have out-of-network coverage?
Patients without out-of-network coverage are “self-pay”. With certain insurance plans, you may be eligible for coverage; however, we cannot guarantee approval by your provider. It is always best to review financial options in the office with our surgical coordinator. But keep in mind that if you do not have insurance coverage or cannot afford treatment, there are several ways to obtain financing to cover the costs.
Get a Second Opinion
Our endometriosis specialists are dedicated to providing patients with expert care. Whether you have been diagnosed or are looking to find a doctor, they are ready to help.Our office is located on 872 Fifth Avenue New York, NY 10065.
You may call us at (646) 960-3080 or have your case reviewed by clicking here.