QC: Why Finding In-Network Endometriosis Specialists Is So Difficult
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QC: Why Finding In-Network Endometriosis Specialists Is So Difficult
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Dr. Jeff Arrington explains why insurance is a major barrier for endometriosis specialists and patients seeking care. The healthcare payment system fundamentally fails to recognize the difference between quick, superficial treatments and proper excision surgery that actually removes the disease.
• Insurance payment systems are based on Relative Value Units (RVUs) set by Medicare
• The RVU system has three components: work involved, malpractice risk, and geographic location
• A superficial 15-minute ablation receives the same insurance payment as a 3-hour expert excision
• The system creates no financial incentive for surgeons to perform proper, thorough excision
• Complex work around sensitive structures like ureters and bowel is not recognized by insurance
• Skilled specialists often can't afford to accept insurance due to this payment inequality
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