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 by clicking the arrow button to the right after each line.
Out‑of‑Network Care
Steven Vasilev, MD, PC is out of network with all insurance plans and does not maintain direct 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.
Worried you’ll be stuck with the bill?
Cost clarity in 60 seconds...
Care associated with the Lotus Endometriosis Institute is provided by Steven Vasilev, MD, PC (a California professional corporation). “Lotus Endometriosis Institute” refers to the specialized clinical program and model of care developed by Dr. Vasilev and his team.
In almost all cases, surgery is performed at an in-network hospital/facility. Your expected responsibility is typically your in-network deductible/copay/coinsurance, subject to your plan’s benefits.
The biggest misconception we see
Choosing an in-network surgeon does not guarantee a lower bill. Choosing a less-experienced surgeon can. The key financial variable is usually your deductible/coinsurance, not whether a surgeon is listed as in-network.
A practical way to think about cost
- Most insurance plans include patient cost-sharing such as 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.
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/facility is in network for your plan
- documentation requirements needed for scheduling
- authorization requirements (if applicable)
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 a “superbill” submission process, often unassisted. Patients should understand that upfront cash payment to a surgeon does not automatically guarantee reimbursement, and reimbursement outcomes can vary widely by 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.
Uncommon situations where payment up front may apply
A small number of arrangements work differently, including health sharing plans (for example, Medi-Share), where the patient may pay up front and request reimbursement directly from their sharing plan entity. This is not a Lotus or Steven Vasilev MD PC policy. It is part of the defined procedure that the sharing plan requires.
***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 our experience, this can expose patients to unnecessary financial strain—particularly when insurance‑supported pathways may ultimately result in lower overall patient responsibility. All care, however, proceeds only within a defined and reviewed financial structure, regardless of payment source.
Our goal is to help patients pursue medically appropriate care without unnecessary financial toxicity. Clinical recommendations are guided by judgment and long-term outcomes, not by a patient’s ability or willingness to pursue aggressive or inappropriate financial arrangements. At the same time, our care is delivered at a level that reflects a narrow, very specialized high-end of the specialty spectrum, based on advanced training, cumulative surgical experience, and the complexity of cases managed. Care is reflective of expertise that is not widely available within standard specialty practice or insurance networks. Accordingly, all care is provided within a clearly defined clinical and transparent financial framework, which is reviewed in advance so patients can make 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.