Academic OB/GYN

Hello Friends and Colleagues –

As of Aug 1, 2018, I am excited to announce my new business and practice Northwest Endometriosis and Pelvic Surgery (NWEPS).  NWEPS is a practice dedicated to providing world-class care to women with complex cases of endometriosis-related pain and infertility, as well as other complex benign gynecologic conditions.

The start of this new practice also marks and end to my relationship with Pearl Women’s Center, my previous practice.

So the big question is why the change?

Well a while back I wrote a popular article that talked about the finances of advanced endometriosis surgery.  We talked about how some physicians were in-network and others were out-of-network.   At that time, I was working in-network on my professional fees, but also had a relationship to an outpatient surgery center where I did most of my work, which allowed me to supplement what I could produce in my professional work.

Over time, I decided that this was not the model under which I wanted to practice.   The biggest reason for this is that an increasing number of the cases I was performing were very complex endometriosis cases that should be done in a hospital rather than a surgical center.  As I discussed before, complex endometriosis surgery pays very poorly in-network, so the reality of this was that I would generate far more income for my practice by doing a simple case in the outpatient surgery center rather than a complex case in the hospital, and in the end this didn’t really align with my desire to do complex advanced cases.   In the end, the only thing we should care about is what is best for the patient, and when somebody is paying you more to do something one way or in one place than some other way or some other place, this is a unneeded distraction from making the best choice for every patient.

I also found that over the three years I have practiced in Oregon, we have had increasing difficulty getting insurance companies to pay on our claims, even at their reduced in-network rates, and irrespective of where surgeries were done.   For example, I have had surgeries that took 6-8 hours of work that were properly coded with 6 or 7 individual procedure codes, where the insurance company refused to pay on more than a single code.  As an in-network physician, there is little one can do about this because of contractual language with the insurance company, so even if one appeals the situation most likely the company just tells you no.

Furthermore, over time I have pushed my practice into areas that insurance companies do not recognize at all, such as neuropelveologic surgery, and as such I would have no hope of being paid for that work under insurance contracts.

As such, I decided to start a new practice that is laser-focused  on endometriosis and complex pelvic surgery.  Due to all the previously mentioned issues, this new practice is entirely out-of-network for insurance plans.

While there are a number of out-of-network endometriosis practices in the country, in one way we are different than the rest.  As out-of-network claims are quite complicated, I have hired a law firm to do my billing – but not against my patients but rather for my patients.  What I have found is that out-of-network billing appeals are extremely complex and a skilled healthcare attorney will be far more effective than a typical billing company, and also far more effective than a patient who does not have a deep knowledge of the insurance system.  This service is provided at no cost to my patients.  This both ensures that I am paid fairly for my work, but also that patients are able to get maximum benefit from their insurance plans and have the minimum in out of pocket expense for their care with my practice.  In cases where my expertise can clearly be shown to unavailable within a patient’s insurance network (which is not uncommon), we often have success in getting out-of-network exceptions, which can dramatically reduce  a patient’s out-of-pocket costs.

Academic OB/GYN as a blog will continue, though new posts will also be cross-posted to my new website http://www.nwendometriosis.com.  Youtube Content will be moved to a new YouTube page as well.  It doesn’t have a link yet but I will update this post when it does.

Thank you so much for your readership of the blog.

If you are interested in clinical consultation please call us at 503-715-1377.  We offer free records reviews, as well as free support for out of network billing appeals as needed.

Sincerely,

Nicholas Fogelson, MD
Northwest Endometriosis and Pelvic Surgery

http://www.nwendometriosis.com