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Frequently Asked Questions

Do you accept insurance?

Dr. Silva has opted out of all insurance contracts, including Medicare. He has done this for your benefit. He does not want your insurance company dictating what he can and cannot do for you, as they are often very limiting. In addition, eliminating a billing department enables him to pass those financial savings on to you. Dr. Silva accepts Visa, MasterCard, Discover, Debit, and Cash/Check for all services performed at IOW.

What can I expect at my initial orthopedic consultation?

During your consultation Dr. Silva will discuss your diagnosis, as well as the treatment options and recommendations he has for you. (A detailed list of items that will be covered in the consultation can be found at the top of this page.)

Following the consultation, our procedure coordinator will review your case with the doctor and promptly send you a packet that summarizes what your recommended treatment includes, a transparent outline of expected fees associated, as well all pre-procedure instructions and post-procedure rehabilitation protocols for the proposed procedure.

What are the fees for the initial orthopedic consultation?

The initial new patient consultation with Dr. Silva is a flat fee of $500. This consultation includes up to 60 minutes of Dr. Silva’s time focused solely on you, review and discussion of previously obtained records such as MRIs and Xrays, a physical exam, and a diagnostic ultrasound exam of peripheral joints. Patients may also have their new patient consultation as a telemedicine (video) appointment, and the fee for this appointment type is $400. The telemedicine consultation does not include a physical exam or ultrasound exam of peripheral joints, which can be reserved for a later date. The initial in-office and/or telemedicine consultations do not include treatment.

What is PRP?

PRP is Platelet Rich Plasma which is created by drawing the patient’s blood and removing all of the red blood cells from the plasma and then concentrating the platelets within the plasma to various concentrations necessary to treat various structures such as tendons, ligaments, bones, muscles, nerves, and joints. We use platelets because they contain a vast array of growth factors and other cytokines which stimulate the body’s healing process. PRP should always be administered by a highly-trained medical doctor using ultrasound or x-ray (fluoroscopic) guidance. PRP is not a stem cell injection.

How much does PRP cost?

This is, of course, a common question. The good news is that our fees are typically lower than what patients expect. We strive to keep the fees as low as possible for the quality of care you will receive.

Dr. Silva will tailor your PRP treatment plan for you, and there are numerous variables that he will take into account as he does this. For example, the degree of pathology, the specific regions he will be treating, and the number of regions that will be addressed in a single intervention are all variables that will be different for you than another patient.

We always want you to know the fees prior to your procedure and will provide you with a breakdown following your consultation.

How much does stem cell therapy cost?

Due to the increased technology and nature of the acquisition of the stem cells, stem cell prices are slightly higher than PRP. Once again, the fees are typically lower than what our patients expect. Many of the same variables as for PRP apply in determining the actual fee for the stem cell procedure.

I live out of state or out of the country – how do I get a consultation and treatment with Dr. Silva?

We offer telemedicine (video) and phone consultations as a starting point for non-local patients and for those who wish to minimize their time in the office due to Covid-19. This type of consultation will include everything that an in-office consult does, except of course the physical exam and ultrasound exam. Typically, Dr. Silva can develop your treatment plan during this consultation. This enables us to appropriately schedule you for a physical exam, ultrasound exam, and treatment for the future on the same day and the same trip.

Do I need an MRI before my consultation?

Dr. Silva does not require imaging (X-RAY, MRI, CT) for your initial consultation. If he deems it necessary, he can order it for you. However, if you already have imaging, he requests that you bring the report along with the images on a CD to your appointment. You can easily acquire these records by contacting the facility that provided the service and requesting it.

What is the difference between autologous stem cell therapy and the amnion/cord blood products that others are offering?

“Stem cells” from a bottle are quite popular right now. These amniotic/placental/Wharton’s jelly products are acquired from a variety of donors around the world, sterilized and dehydrated into a powder, or cryopreserved, packaged, and finally sold to doctors for use on their patients. Currently, there is a disturbing trend of undertrained physicians selling these donor tissue products as live stem cells or “stem cell therapy” to patients who don’t know any better, but these are dead tissues and are regulated as such by the FDA. Therefore, any doctor or practitioner who calls these therapies as “stem cell therapy” is practicing fraudulent medicine. Part of Dr. Silva’s mission is to provide education to his patients and the greater community so that they can be empowered consumers of medicine, armed with the knowledge needed to protect themselves from being ripped off by practitioners making such false claims.

What is stem cell therapy?

Stem cell therapy for musculoskeletal conditions is derived from bone marrow concentrate (BMC). Inside your bone marrow live a variety of immune cells, including mesenchymal stem cells, which are extracted and then concentrated into to be used as your cellular medicine in orthopedic procedures. BMC is one of the strongest biologics used in orthopedic procedures and is typically used for more severe cases of tendon or ligament tears, osteoarthritis, and joint degeneration. Stem cells act as a general contractor to organize the repair through a variety of cytokines and exosomes, but they may also become the brick and mortar needed for tissue repair. The end result is stronger tissue and an improved ability to handle stress which will result in better biomechanics and decreased pain.

What is prolotherapy?

Prolotherapy is short for proliferative therapies which are various types of injectates which stimulate an inflammatory response which encourages the body’s healing process with the intent of repairing injured tissue such as ligaments and tendons. The end goal would be to stabilize and strengthen joints to reduce your pain and improve their function.

There are multiple types of prolotherapy, from mild to very strong, and this should be customized to the patient’s pathology.

What is regenerative medicine?

Regenerative medicine is a non-surgical approach to heal damaged tissue and disease that contributes to pain and dysfunction. In our practice, we attempt to address underlying problems that are creating the patient’s complaints. This is in contrast to the majority of medical treatments that are designed to address symptoms without addressing the underlying cause of those symptoms. To regenerate a joint, we utilize therapies that aim to strengthen all of the tissues that make the joint work appropriately, and the subsequent improvement of biomechanics will lead to reduced or eliminated pain, improved stability, and a better functioning joint for the long run.

A regenerative procedure works with the body’s natural process of healing, starting by stimulating inflammation, followed by the proliferation of new tissue, and then maturation of that new tissue over time. When utilizing Prolotherapy, PRP and/or Cellular Therapy, these stages of healing occur over several weeks to months. In order for this process to occur, and for the patient to achieve their optimal outcome, these must be precisely placed under image guidance into the degenerative tissue. You cannot get this result of healing by just blindly injecting the substance into the joint (be it PRP or Cellular Therapy), although this is how many of the less skilled practitioners administer PRP and fake “stem cells” from a bottle. Always check your “regenerative medicine” doctor’s credentials, as many practitioners inflate or misrepresent their experience, credentials, and expertise with regard to the substances they inject, ultrasound and fluoroscopic image guidance, and musculoskeletal injection techniques. Dr. Silva is a board-certified Physical Medicine & Rehabilitation doctor with specialty fellowship training in Interventional Orthopedics. Click here to learn more about his credentials.

What is the recommended follow-up protocol after regenerative procedures?

There are a variety of things that need to be done before and after injections to improve the overall outcome. Unfortunately, many doctors are not aware of all of the protocols and precautions necessary to support the optimal outcome.

Many times, this includes lifestyle modifications, rehabilitation exercise, changing /reducing/discontinuing medications, optimizing disease, and utilizing a brace. Dr. Silva recommends a PREhab protocol to prepare for the procedure and then a rehab protocol for a minimum of 6 weeks after injections. Your PREhab and rehab will and should be customized to you, and Dr. Silva will talk about this at length during your evaluation in order to maximize your long-term results.

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Are you a wellness provider such as a Primary Care Physician, Naturopathic Physician, Chiropractor, Occupational Therapist or Physical Therapist? Do you utilize natural, holistic or functional medicine methodologies in your practice? Do you have patients suffering from unresolved or chronic pain issues, or patients wondering if their best option truly is to manage chronic pain with medications or unwanted surgery? Do you strive to practice HEALTH care, not sick care? If the answer is yes to these questions, then we should talk.

1515 116th Ave NE, Suite 202,

Bellevue, WA 98004

Otoño Silva, MD

Fax: 425-326-1667



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