How Insurance Works at Resilience Orthopedics
Orthopedic Care Without Insurance Delays
At Resilience Orthopedics, you get direct access to advanced treatments and focused care from your orthopedic doctor at every step.
The traditional system can be exhausting. You are in pain, but you are stuck waiting weeks, sometimes months, just to be seen. When you finally get in, the visit feels rushed, and you may leave without clear answers.
That’s exactly what we aim to change. Dr. Pamela Mehta runs a direct-care, out-of-network practice that removes these delays and restrictions.
You do not need referrals to be seen, and you do not have to wait for insurance approval to move forward with your treatment. Instead, you’ll get transparent pricing from the start, with no hidden costs or unexpected bills later.
Your treatment plan is built around your condition and your goals, not limited by insurance rules or algorithms. You get faster access, clearer answers, and a more direct path to treatment.
How Insurance Works at Resilience Orthopedics
PPO Insurance Plan
A PPO plan gives you more flexibility than most insurance options. It allows you to see specialists outside your network without a referral.
Even with that flexibility, many people still feel uncertain about costs and reimbursement. We walk you through everything up front so you know what to expect before making any decisions.
Here’s how it works:
- You pay at the time of your visit in a simple, transparent process.
- Our team submits your out-of-network claim directly to your insurance provider.
- You receive reimbursement based on your PPO out-of-network benefits.
- Your payment is typically applied toward your annual out-of-network deductible.
HMO Plan
With an HMO plan, seeing a specialist typically requires a referral from your primary doctor first. It’s also worth knowing that HMO plans generally do not reimburse for out-of-network care, so visiting Resilience Orthopedics under an HMO would function similarly to a self-pay arrangement. If you’re unsure whether that works for your situation, our team is happy to walk you through your options before you commit to anything.
At Resilience Orthopedics, you can move forward without those delays:
- Schedule directly without referrals or approvals.
- Know your costs before any visit or procedure.
FSA or HSA
HSAs and FSAs let you use pre-tax dollars for medical care, giving you more flexibility in how you manage treatment costs.
These funds can be used for consultations, imaging, procedures, and follow-up care. They can also be applied to regenerative treatments like PRP and stem cell therapy. (They can also be applied to regenerative treatments like PRP and advanced cellular therapies such as bone marrow aspirate concentrate (BMAC).)
Payment is processed like a standard card transaction, and itemized receipts are provided if needed.
Courtesy Billing and Superbills
You do not have to handle the paperwork. After your visit, our team prepares and submits your out-of-network claim to your insurer. If you would rather submit it yourself, we provide an itemized superbill with the diagnosis and procedure codes your plan needs.
Courtesy billing does not change what your plan pays. It ensures the claim is filed the first time correctly, with the right codes, so nothing gets delayed or denied because of a paperwork error. Your insurer sends any reimbursement directly to you.
Do I Need Pre-Authorization?
To see Dr. Mehta, no. You can book directly and be seen without waiting on your insurer.
Pre-authorization can still apply to the parts of your care that run through in-network provideras, such as an MRI, an outpatient surgery center, or physical therapy. Those providers bill your plan directly, and your plan may require approval first. Our team submits and tracks those requests, so you aren’t the one chasing anyone.
A Quick Note on Coverage
We are not able to accept Medi-Cal or Medicaid. We are able to offer significant discounts if you have Medicare. Please contact the office if you are unsure about your coverage.
Can I Use Cash Pay (Direct Pay) Instead of Insurance?
Yes, you can receive treatment at Resilience Orthopedics without using insurance.
Some patients choose a cash pay or direct pay approach because they do not have coverage, prefer not to use insurance, or want to avoid delays and restrictions.
This is also common for regenerative treatments that are not included in standard insurance plans. If you move forward this way, the process is simple and transparent:
- You’ll know the cost of your visit or procedure before treatment.
- Payment is made at the time of service, with no hidden fees.
- There are no referrals, approvals, or added administrative steps.
This model also gives you more flexibility in how your treatment is planned. For regenerative options like PRP or stem cell therapy, this is often the most practical way forward.
If helpful, we can provide itemized documentation for you to submit to your insurance provider.
What You Can Expect at Resilience Orthopedics
We remove unnecessary barriers so your care stays straightforward from the start. Here is what that looks like for you:
- Faster access to treatment: There are no insurance approvals or administrative delays slowing things down. When treatment is needed, Dr. Mehta can move forward without unnecessary waiting.
- Continuous care with Dr. Mehta: You are seen and followed directly by Dr. Mehta throughout your treatment. This ensures consistency and continuity in your care over time.
- Access to advanced treatment options: We offer regenerative and advanced therapies when appropriate, based on your condition, without being limited by insurance restrictions.
- More time at each visit: Appointments are structured to allow proper time for evaluation and discussion so your condition can be fully understood and your questions addressed without rush.
What Happens If I Need Surgery?
Surgery can feel complex, especially with out-of-network care. At Resilience Orthopedics, we make the process clear and structured so you know what to expect at every step.
How it Actually Works
Your surgeon’s fee is only one part of the overall cost. The facility, anesthesia, imaging, and rehabilitation are billed separately. That’s why we only refer you to in-network surgery centers, imaging providers, and physical therapists, so these parts of your care stay in-network.
How Your Surgical Care is Structured
Before your procedure, we break everything down clearly so there are no surprises.
Your surgical care may include in-network care with:
- Outpatient surgery center
- Anesthesia services
- Imaging (such as MRI when needed)
- Post-operative physical therapy (if required)
And when you have surgery with Dr. Mehta, your post-op appointments are covered for 90 days.
Recovery After Surgery
Your recovery is structured and supported for 90 days after your procedure. This includes:
- Follow-up visits with your surgeon
- All in-office recovery appointments
- Post-operative X-rays when needed
There are no additional visit charges during this recovery period.
Clear Financial Expectations
Before your procedure is scheduled, you receive a clear breakdown of:
- Your surgical fee
- What your insurance is expected to cover
- Your estimated out-of-pocket cost
Everything is reviewed up front so you know exactly what to expect.
Flexible Payment Options
At Resilience Orthopedics, we accept:
- Credit and debit cards
- Cash payments
- Health Savings Accounts (HSA)
- Flexible Spending Accounts (FSA)
HSA and FSA funds can also be used for consultations, surgery, and regenerative treatments like PRP.
What Happens Next?
After you schedule your consultation, we evaluate your condition and walk you through a clear treatment plan.
You will get a clear idea about your options and what each path would look like. From there, you decide how you want to move forward, with full clarity and no pressure.
Ready to Schedule an Appointment?
Let’s get you back to doing what you love. Call or email us to book your consultation today.