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Patient Info / Surgical Financial Clarity

Surgical Financial Clarity

“I’ve never had a patient regret investing in their health… …I’ve had many heart-wrenching discussions with patients who regret NOT having invested in their health.”

— Bill J. Metaxas, DPM

We are proud to be one of only a handful of clinics nationwide featuring Dr. Metaxas’ expertise in minimally invasive techniques combined with advanced 3D imaging and—perhaps most critically—dedicated to delivering unhurried, personalized care.

If you are reading this, you are considering a significant surgical solution for a complex structural problem. To provide you with absolute diagnostic confidence, we invest our time heavily upfront, engineering a precise, scientifically backed treatment roadmap before any final decisions are made.

Our Foundational Standard: Learn • Educate • Innovate • Advocate →
Our first priority is empowering you to choose the absolute best solution for your health—advancing beyond outdated, least-expensive treatments dictated by standard insurance coverage. Only after your optimal path is established do we work to maximize your health benefits to support that goal.

Consultation Pathways

Depending on the complexity of your case and where you are in your treatment journey, our practice provides two distinct clinical pathways:

Pathway 01

Initial Baseline Consultations

For patients establishing care without prior surgeries or revisions, focused on clinical diagnostics and non-surgical care.

Insurance Coverage & Integration

Standard initial consultations to establish care and perform baseline evaluations can often be billed directly to your health insurance.

This allows seamless integration with your existing network coverage for foundational diagnostics, clinical exams, and early conservative treatment.

Pathway 02

Second Opinions & Comprehensive Reports

For complex, chronic, or previously surgical cases requiring unhurried diagnostic synthesis and an executive-level treatment roadmap.

View Consultation Fee & Inclusions
$2,000 Bespoke Self-Pay Investment
  • In-Person Clinical Exam: Unhurried, comprehensive structural evaluation directly with Dr. Metaxas.
  • Advanced 3D Imaging: Northern California’s exclusive CurveBeam® PedCAT™ weight-bearing 3D CT scan.
  • Records & Operative Audit: Detailed review of prior surgical operative notes, imaging, and history.
  • Action Proposal: Customized written summary report and definitive surgical treatment proposal.
Reconstructive Excellence

The Surgical Reconstructive Investment

Because every patient presents unique biomechanics, surgical fees are evaluated individually based on anatomic complexity and the specialized, minimally invasive techniques required.

View Surgical Fee Structure & Value Breakdown
$8,000 – $10,000+ Typical Surgical Investment Range

This investment secures Dr. Metaxas’ private operative expertise, meticulous perioperative management throughout your recovery, and access to proprietary regenerative protocols. Routine post-operative follow-up visits and imaging can often be billed directly to your health insurance.

Why Health Insurance Excludes State-of-the-Art Outpatient Surgery

Through navigating hundreds of health plans, we know that health insurance is a financial hedge against catastrophic medical emergencies—not a fund for state-of-the-art outpatient care. Governed by cost-control metrics rather than current medical science, standard policies routinely exclude the advanced, minimally invasive reconstructive techniques proven to accelerate patient recovery.

Maximizing Your Coverage: Surgery Center & Anesthesia Fees

Dr. Metaxas’ surgical fee is strictly for his private clinical expertise; it does not include the accredited surgery center, anesthesia, surgical hardware/implants, or post-operative bracing.

Maximizing Your Insurance Benefits & Facility Coverage

Our dedicated billing team will do everything possible to maximize your health insurance benefits. Depending on your specific policy, some health plans provide coverage and payment for the accredited outpatient surgery center, certified anesthesia services, and related medical supplies (subject to individual patient deductibles and cost-shares).

Review our comprehensive guide to understand insurance realities →

Frequently Asked Questions

Why doesn't my health insurance pay for this?

In short, because health insurance pays for "big things" not every thing.

Health insurance is a financial product designed to protect you from catastrophic medical emergencies, not to fund state-of-the-art, specialized outpatient care.

Policies are strictly governed by cost-control metrics rather than modern medical science, which means they routinely exclude the advanced, minimally invasive reconstructive techniques Dr. Metaxas utilizes to accelerate your recovery.

• Whether you are covered by an Employer Sponsored Plan (ERISA) or a PPO plan (governed under the Affordable Care Act) insurers prioritize the least expensive, outdated standard of care.

• Medicare historically excluded Podiatric care from its original mandate, and notoriously restricts coverage and reduces payments annually under rigid bureaucratic guidelines driven by systemic budget deficits.

To understand exactly how your specific plan limits your treatment options, you can review our detailed guides on Employer Sponsored (ERISA), PPO Plans, and Medicare,

My insurance told me my surgery is "covered subject to the terms of my plan." Does that mean they will pay for it?

This is one of the most common questions we face, and it is frustrating because Insurance is frequently misleading to give the impression of greater value for your healthcare dollar. Here's the detail:

No. In the health insurance industry, "covered" simply means the procedure code exists in their system—it is never a guarantee of payment. Insurance representatives are trained to use non-committal language to shift financial liability back to the patient.

If an insurance representative claims a procedure is covered, we highly recommend calling them back and demanding they answer these exact questions:

• Can you certify medical necessity for this procedure?

• Does my policy consider this medically necessary?

• Can you certify coverage for this procedure?

• Does my policy provide coverage for this procedure?

• Can you certify payment for this procedure?

• Can you certify the payment amount for this procedure?

• What is the exact payment amount for this procedure?

• Can you guarantee in writing that payment will not be retroactively denied after my treatment is completed?

If they refuse to provide these guarantees in writing, they are legally protecting their right to deny your claim later.

This is exactly why Dr. Metaxas operates on a transparent, fee-for-service basis for his surgical expertise, ensuring you know your exact investment upfront without relying on insurance loopholes.

My insurance plan contacted me to warn me about "massive out-of-pocket costs" or denials if I proceed. Why?

This is a standard industry scare tactic designed to prevent you from seeking specialized treatment.

Insurance companies win when you do nothing; if you are intimidated out of proceeding with your surgery, they are entirely off the hook for any expenses.

You must remember the fundamental difference in our roles: Doctors practice medicine, while health insurance companies practice cost control.

Our first priority is empowering you to choose the absolute best solution for your health.

We protect your health decisions by providing absolute financial clarity upfront, ensuring you never have to compromise your recovery due to third-party intimidation. A Doctor's job is to help a patient make the best decision for their health, not to help an insurance company's cost savings goals.

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San Mateo Podiatry Group
1750 El Camino Real, Suite 106
Burlingame, CA 94010

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