Why Excision Surgery Isn't Covered: The Broken System Behind Endometriosis Care
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Why Excision Surgery Isn't Covered: The Broken System Behind Endometriosis Care
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Season 2, Ep 22
Welcome to The Chronic Chronicles, I'm SO happy that you're here!
In today's episode, I'm diving deep into one of the biggest and least understood barriers in endometriosis care: why excision surgery (the gold standard treatment) is normally not covered by insurance. We'll talk about how the CPT (Current Procedural Terminology) system works, why excision and ablation are still billed under the same code, and the history of bias and misunderstanding in gynecology that led us here. I'll also break down what the AMA, ACOG, payers, and policymakers have (and haven't) done and why this matters for every single person with endo. We'll cover the real reasons behind high out-of-pocket costs, the financial strain on surgeons performing complex excision, and what everyday people can do to push for change right now. Sources:- American Medical Association (AMA): CPT Editorial Process & Applications
- ACOG Committee Opinions on Endometriosis Diagnosis & Management
- 2021 Congressional Endometriosis Advocacy Reports
- Peer-reviewed comparisons of excision vs. ablation effectiveness
- Surgeon reimbursement data published in health policy analyses
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