Fall & winter care
Innovare TxRegenerative & Wellness
Knee Program · Costs

What it costs, and what your plan actually covers

Knee care splits cleanly into two columns: the part your insurance is designed to pay for, and the part it is not. Here is which is which, before you book anything.

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In short
The medical pathway — evaluation, physical therapy, imaging, labs and referrals — is generally billable, and Innovare Tx accepts 200+ plans including Aetna, Blue Cross Blue Shield, Cigna, Medicare and United Healthcare. Autologous orthobiologic procedures are cash-pay and are quoted in writing after your evaluation, because they are investigational and insurers do not cover them. Our billing team verifies your benefits before your first visit.

The two columns

Generally billed to insurance

  • The initial knee evaluation and follow-up office visits
  • Physical therapy with Rowena Calleja, PT
  • In-office diagnostic ultrasound
  • X-rays, MRI and other imaging we order
  • Laboratory work
  • Referrals to orthopedics, rheumatology or interventional radiology
  • Federal workers' compensation (OWCP) knee claims

Cash-pay, quoted after evaluation

  • PRP — platelet-rich plasma
  • PPP — platelet-poor plasma
  • BMAC — bone marrow aspirate concentrate
  • A2M — alpha-2-macroglobulin
  • Wellness membership modalities

Why the orthobiologic column is cash-pay

PRP, PPP, BMAC and A2M are considered investigational and are not FDA-approved for the treatment of any specific orthopedic condition. Insurers do not reimburse procedures carrying that status, and we are not going to imply otherwise in order to make the decision feel easier. If a clinic tells you it can get an orthobiologic knee injection covered by your plan, ask exactly what code it intends to bill.

We also do not quote these prices on a web page or over the phone. The appropriate procedure — if any is appropriate — depends on findings nobody has yet. You get a written quote after the evaluation, and you are never asked to decide on the same day you first hear the number.

How benefit verification works here

  • Call or send a request with your plan details before your first visit
  • Our billing team checks eligibility, deductible status, visit limits and authorization requirements
  • You get an estimated out-of-pocket figure for the visit type you are booking
  • Anything cash-pay is separated out and quoted on its own, in writing
  • If the plan changes mid-pathway, the estimate is redone rather than assumed

Full detail on plans and billing is on our insurance and billing page.

If your knee injury happened at work

Innovare Tx is an established provider for federal workers’ compensation claims through the Office of Workers’ Compensation Programs. Charles Ortega, PA-C performs the clinical work and Dr. Nathan V. Nguyen, MD serves as treating physician on OWCP cases, which matters because the federal program has specific requirements about who may sign what. We do not take Texas state workers’ compensation. Start with the OWCP guide, or read the federal employee’s guide to OWCP care.

What GAE costs

We cannot tell you, because we do not perform it and do not bill for it. Coverage for genicular artery embolization is limited and inconsistent given its investigational status, and the figure comes from the interventional radiology practice that would do it. Ask them for it in writing before you schedule anything.

PRP, PPP, BMAC, and A2M are autologous procedures prepared from your own blood or bone marrow. They are considered investigational and are not FDA-approved for the treatment of any specific orthopedic condition, including osteoarthritis. Individual results are not guaranteed. Any decision to pursue an orthobiologic procedure should be made with your provider after a clinical evaluation.

Questions, answered

Cost & coverage FAQs

It is quoted in writing after your evaluation, because the price depends on which procedure is appropriate and what is involved. We do not quote a figure over the phone before anyone has examined your knee, and you will never be asked to commit to a procedure on the day you first hear the number. These procedures are not covered by insurance.
Because they are considered investigational and are not FDA-approved for the treatment of any specific orthopedic condition. Insurers do not generally reimburse procedures with that status. That is not unique to our clinic, and any practice telling you it can get these billed to your plan is worth a second look.
Generally the medical parts of the pathway: the office visit and evaluation, physical therapy, diagnostic imaging, laboratory work and any specialist referral. Innovare Tx accepts 200+ plans including Aetna, Blue Cross Blue Shield, Cigna, Medicare and United Healthcare. What your specific plan covers depends on your deductible, visit limits and any authorization requirement — which is exactly what we verify before you come in.
We will tell you what we can confirm. Our billing team verifies your benefits and explains the estimated out-of-pocket cost for the visit type you are booking. An estimate is an estimate — the final amount depends on what your plan applies to your deductible — but nobody should walk into a clinic with no idea of the number.
Coverage for GAE is limited and inconsistent, because it is investigational for knee osteoarthritis. Cost and coverage are determined by the interventional radiology practice that would perform it, not by us. Ask them directly and ask for it in writing before you schedule. We explain the procedure and refer; we do not perform or bill for it.
No. We accept federal workers' compensation through the Office of Workers' Compensation Programs (OWCP) but we do not take Texas state workers' compensation claims. See our OWCP guide for how federal claims work at Innovare Tx.

Know the number before you book

Send us your plan details and our billing team will verify your benefits first.

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