Why So Many Endometriosis Specialists Are Out of Network — And Why It Matters

If you’ve been told that an endometriosis specialist is “out of network,” you’re not alone, and more importantly, it’s not random. There’s a reason behind it. And understanding that reason is key to understanding why access to proper care is so limited.

The Core Issue: Insurance Doesn’t Differentiate Quality of Care

Insurance companies assign value to surgical procedures using standardized billing codes. But when it comes to endometriosis, these codes fail patients in a critical way:

They treat all endometriosis surgeries as if they are the same.

That means:

  • Superficial ablation (burning or lasering lesions)

  • Partial treatment

  • Complex, full excision surgery

…are often reimbursed at the same rate.

But these procedures are not the same.

Excision Surgery Is More Complex—But Not Valued That Way

Excision surgery (the gold standard for treating endometriosis) requires:

  • Advanced surgical training

  • Significantly more time in the operating room

  • The ability to treat disease across multiple organs (bowel, bladder, diaphragm, and more)

  • A meticulous, full-body evaluation to identify even subtle disease

In contrast, less comprehensive approaches may take a fraction of the time and do not address the full extent of the disease.

Yet, under current reimbursement models, insurance often:

  • Bundles complex procedures into a single code

  • Fails to account for time, skill, or disease severity

  • Pays multiple surgeons separately—but not a single highly trained specialist performing the same work

Why Specialists Opt Out

Because of this mismatch, many highly trained excision specialists cannot sustainably operate within insurance networks.

Being “in-network” would mean:

  • Being reimbursed at rates that don’t reflect the complexity of care

  • Limiting the time they can spend with each patient

  • Potentially compromising the thoroughness required for effective treatment

Instead, many choose to remain out of network so they can:

  • Provide complete, uncompromised excision surgery

  • Spend the necessary time to fully evaluate and treat disease

  • Deliver care aligned with best practices, not insurance limitations

The Reality for Patients

Unfortunately, this system places the burden on patients:

  • Higher out-of-pocket costs

  • Limited access to true specialists

  • Delayed or inadequate treatment

And for many, it creates an impossible choice between affordability and quality care.

Where We Come In

At Endo Excision for All, we exist because this gap should not exist. We fund access to excision surgery for patients who would otherwise be unable to afford it, not because the care is optional, but because it is essential.

We believe:

  • Patients deserve access to the highest standard of care, regardless of income

  • Insurance systems should reflect the true complexity of endometriosis treatment

  • No one should have to choose between financial stability and relief from a debilitating disease

Until systemic change happens, we are committed to bridging that gap… One patient at a time.

Endo Excision for All is a 501(c)(3) nonprofit dedicated to ensuring equitable access to excision surgery, the gold standard in endometriosis treatment.