Starting Care at Lotus
Your Care Begins With Clarity
Getting Started
What to expect as you begin care with us
If you’re new to the Lotus Endometriosis Institute, you may be feeling a mix of hope, skepticism, and emotional or mental fatigue—especially if you’ve been dismissed, gaslit, misdiagnosed, or treated elsewhere without any lasting relief you may have been promised.
This guide explains what to expect as a new patient: how our intake process works, how telehealth is used, how insurance and financial considerations are handled, and how out-of-area patients from across the 49 mainland states and Hawaii plan for in‑person care in California.
Clarity from the start
A structured, step‑by‑step process
Our goal is to provide clarity before you invest time, travel, or emotional energy. Most patients move through care in the following way:
- Preliminary record submission and review
- Telehealth consultation, if we believe we may be able to help
- Further planning, including determining whether in‑person evaluation or surgery in California is appropriate
- Surgery and coordinated follow‑up, when indicated
This is not a one‑size‑fits‑all pathway. Endometriosis can be complex, involve multiple organ systems, and vary significantly from patient to patient. We will be direct about what we believe is likely to help, what remains uncertain, and what steps make sense next.
You're not alone in this
Patients we commonly help
Many patients who come to us have:
Been told nothing is wrong despite continued symptoms
Persistent symptoms despite prior treatment
Prior surgery with incomplete relief or recurrence
Complex or deeply infiltrating disease
Questions about surgery, is it necessary—and if so, what kind
The need to travel for highly specialized care not available locally
Begin your personalized care plan with us today, and embark on your journey towards a healthier, more comfortable life.
Step One: Telehealth Consultation
Selective, record‑based, and purposeful
Telehealth consultations are informational and free, but they are not casual. Before a telehealth visit is scheduled, our team conducts a preliminary review of your symptoms and available medical records. This allows us to determine whether a consultation would be meaningful and whether we believe we may be able to help. If, after review, we believe your case may be appropriate for care here, we will:
- Tell you so directly
- Let you know exactly what additional records or information are needed
- Proceed with scheduling a telehealth informational consult session
If we do not believe a consultation would be helpful, we will tell you that as well. We believe clarity is more respectful than false reassurance.
For patients located outside of California, virtual consultations are limited to record review and discussion of care options and do not constitute medical diagnosis or treatment. Medical and surgical care is provided in person at affiliated facilities in California, in accordance with applicable state licensure requirements.
Records are required
We are not able to schedule telehealth consultations without records. You do not need to gather everything at once. To begin, we ask that you submit what you have available, which may include:
- Operative reports from prior surgeries
- Pathology reports
- Imaging reports (and images, if available)
- A brief treatment history
After initial review, our team will tell you exactly what additional records are needed, if any.
Purpose of telehealth
Telehealth is used to:
- Review history, symptoms, and prior treatment
- Discuss what may be contributing to ongoing symptoms
- Determine whether in‑person evaluation or surgery in California may be appropriate
- Set expectations before travel is considered
Telehealth is designed to expedite and define the care process for patients who are both residents of California or considering establishing care in California if indicated.
Why Telehealth?
Telehealth vs In‑Person Care
What can be done remotely
Telehealth allows patients from across the 49 mainland states and Hawaii to have their cases reviewed thoughtfully before making commitments of time, travel, or expense.
What requires in‑person care
Certain aspects of care cannot be done remotely of course, including:
Physical examination & testing
Surgical procedures
Perioperative management and recovery
When in‑person care is recommended, patients travel to California for evaluation and treatment.
A routine part of our care model
Traveling to California for Care
Many patients who seek care through the Lotus Endometriosis Institute live outside California. Traveling for specialized care is a normal and well‑established part of our practice model. If surgery is recommended, our team helps patients plan appropriately, including timing, recovery expectations, and coordination with local physicians when needed.
Typical length of stay
Most patients should plan to remain in California for approximately one week following surgery. In select situations, a shorter stay may be appropriate—typically when:
The surgical case is not highly complex
The patient is traveling by car to an adjoining state
Postoperative planning supports this safely
Your specific plan will be discussed based on your clinical situation.
Deciding on Surgery
Procedures and Surgical Scope
Endometriosis can involve multiple organ systems and vary widely in severity and presentation. Surgical planning is individualized and based on careful review of prior records, imaging, and clinical history. During telehealth and follow‑up discussions, we will explain:
- Whether surgery is likely to be beneficial
- The anticipated scope of surgery
- What recovery may involve
- How care is coordinated before and after treatment
We will also be clear if surgery is not recommended or if alternative steps should be considered first. You can read more about our surgical approach and the various surgical procedures we provide when tailoring your care to you.
Helping you navigate the practical details
Insurance, Cost, and Financial Transparency
Care associated with the Lotus Endometriosis Institute is provided by Steven Vasilev, MD, PC, a California professional corporation. The Lotus Endometriosis Institute refers to the specialized clinical program and model of care developed by Dr. Vasilev and his team. All medical services, billing, and regulatory compliance are conducted through Steven Vasilev, MD, PC in accordance with California and applicable federal requirements.
Please review all of the following information bullets below or visit our billing and insurance page.
Out‑of‑Network Care
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.
Patient Advocacy Support
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.
What Will This Actually Cost Me?
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.
What about Cash‑Pay?
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.
What our patients are saying
Learning From Other Patients
Many patients who come to us share similar challenges—delayed diagnosis, incomplete treatment, or uncertainty about next steps. Patient stories are shared to provide perspective and insight into how others navigated care decisions, travel, and recovery.
Ready to Begin?
Next Steps
If you are considering care through the Lotus Endometriosis Institute, please review the Pre‑Consult Expectations and submit your records for preliminary review. If we believe we may be able to help, we will guide you through the next steps, beginning with a telehealth consultation. If we believe another approach would better serve you, we will tell you directly and help guide you toward the most appropriate next step.
Common Questions
How do I make the most of a short endometriosis appointment?
Go in with a one-page snapshot of your story so the limited time is spent on decision-making, not backtracking. The most helpful snapshot includes: your top 2–3 symptoms, the pattern (cyclical vs daily, triggers, where pain starts and spreads), what you’ve already tried and what happened, and what your symptoms keep you from doing (work, school, intimacy, exercise). If you have a history of “normal” scans, bring that too—because imaging can miss endometriosis, and the pattern of symptoms and prior response to treatment still matters.
Bring the right records if you have them—especially operative reports, pathology, and imaging reports (and ideally the actual images). Then decide your goal for the visit: diagnostic clarity, a plan to evaluate look-alike or coexisting conditions, or a clear surgical discussion (whether surgery is likely to help, anticipated scope, and what recovery may involve). If you want to make the appointment count even more, reach out to our team ahead of time so we can review what you’ve already done and tell you exactly what information would be most useful for a focused, productive conversation.
What questions should I ask an endometriosis specialist?
Come in focused on how your surgeon thinks and how your care will be mapped out. Helpful questions include: based on my symptoms and records, what diagnoses are you considering (endometriosis, adenomyosis, and common look‑alikes), and what makes you lean one way or another? Ask what additional records or imaging would meaningfully change the plan, and whether your imaging will be interpreted with endometriosis mapping in mind—not just a “normal/abnormal” read.
If surgery is on the table, ask for specifics about technique and scope: do you primarily perform excision (rather than superficial burning/ablation), and how do you confirm what was removed (photos, operative report detail, pathology)? Ask what areas you expect could be involved in your case (ovaries, bowel, bladder/ureters, diaphragm) and whether a multidisciplinary team is planned if those organs may be affected. It’s also reasonable to ask how they define surgical “success” for your goals—pain relief, bowel/bladder function, fertility—and how outcomes and recurrence/persistent symptoms are handled.
Finally, ask how the care process works from start to finish: what the pre‑op workup includes, what recovery typically looks like for the anticipated complexity, and how follow‑up is structured if symptoms don’t resolve fully. In our practice, we review records purposefully before meeting so the conversation is productive and realistic, and we’ll be direct about whether surgery seems likely to help or whether another path makes more sense. If you’d like, you can reach out to schedule a consultation and we’ll tell you exactly what to send first so we can make your visit worth your time.
How do I document endometriosis for work accommodations?
Documenting endometriosis for work accommodations starts with creating a clear paper trail that connects your diagnosis (or suspected diagnosis) to specific functional limits at work. Keep a simple symptom log for at least 4–8 weeks: date, symptom (pelvic pain, fatigue, bowel/bladder pain, heavy bleeding), severity, duration, triggers, and exactly what work tasks were affected (missed shifts, reduced standing tolerance, inability to sit, concentration issues, frequent bathroom breaks). Save objective documentation too—operative and pathology reports if you’ve had surgery, imaging reports when available, ER/urgent care notes, medication or treatment history, and any workplace attendance or performance impacts that occurred during flares.
For an accommodation request, what usually helps most is a concise clinician letter that focuses on work restrictions rather than extensive medical detail—e.g., need for flexible scheduling during flares, ability to work from home at times, breaks for pain management/restroom access, limits on prolonged standing/sitting, or intermittent leave when symptoms are unpredictable. If you’re pursuing disability benefits, the same principle applies: decision-makers look for consistent records over time showing that symptoms significantly interfere with your ability to perform job duties, since endometriosis isn’t automatically classified as a disability.
Our team can help you organize the records that best support your case and, when appropriate, provide medical documentation that reflects the reality of your symptoms and functional limitations. If you’d like, reach out to schedule a consultation so we can review what you already have and identify what additional documentation would be most useful for workplace accommodations.
How do I explain endometriosis to my employer?
It often helps to keep your explanation simple and work-focused: endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside the uterus and can cause significant pelvic pain, fatigue, and GI or bladder symptoms. Symptoms can flare unpredictably and aren’t always limited to your period, which is why you may need flexibility at certain times. You don’t need to share intimate details—just the functional impact (for example: pain, fatigue, and medical appointments can affect attendance, sitting/standing tolerance, or concentration).
If you’re requesting support, be specific about what would help you do your job well, such as intermittent time off for flares, the ability to work from home when symptoms spike, scheduled breaks, or flexibility around medical visits and potential procedures. Many patients find it useful to frame this as a long-term health condition with variable days rather than a one-time illness, and to document patterns of symptoms and missed work so your needs are clear.
If you’d like, our team can help you describe your condition and anticipated care in a medically accurate way that supports workplace accommodations, especially if symptoms are affecting your ability to function consistently. You can also explore our educational resources on endometriosis and work impacts, and reach out to schedule a consultation if you’re looking for a clearer plan for diagnosis and treatment.
Is it normal to feel like you’re making up endometriosis symptoms?
Yes—this is incredibly common, and it usually happens because you’ve been living in a system where pelvic pain is often normalized, minimized, or explained away. When tests come back “normal,” or you’re told it’s stress/IBS/UTIs without a cohesive plan, it can start to feel like the problem must be you. Endometriosis symptoms can be wide-ranging and sometimes seem unrelated, which makes self-doubt even easier to fall into—especially if you’ve had years of mixed messages.
In our practice, one of the first goals is validation through clarity: we take your full story seriously, look for symptom patterns and flare timing, and evaluate for endometriosis along with common look-alike or coexisting conditions that can amplify pain (like pelvic floor dysfunction, central sensitization, GI imbalance, or vascular causes). Endometriosis can cause many symptoms, but it doesn’t explain everything—so we’re careful and specific about what fits, what doesn’t, and what to investigate next. If you’re stuck in the “maybe it’s nothing” loop, reach out to schedule a consultation so we can help make your symptoms clinically legible and build a real path forward.
Can endometriosis qualify as a disability?
Yes—endometriosis can qualify as a disability in some situations, but it isn’t “automatically” considered one in every case. When symptoms like pelvic pain, fatigue, bowel/bladder pain, or pain with sex significantly limit day-to-day functioning, a person may be protected under the Americans with Disabilities Act (ADA) and may be eligible for workplace accommodations.
For Social Security disability benefits, endometriosis is not a listed condition, so approval typically depends on showing how your symptoms and functional limitations prevent you from sustaining work. Documentation matters: clear diagnosis details, treatment history (including surgery and symptom management), and records describing how often symptoms flare and what activities they limit. If you’re navigating work or disability questions, our team can help evaluate the medical side of your case, clarify the disease versus pain mechanisms (including central sensitization), and create a plan that supports both symptom control and long-term treatment goals—reach out to schedule a consultation.