Is your orthopedic care "off the rack?"

When you walk into an orthopedic clinic, are you getting a one-size-fits-all protocol or a treatment plan designed specifically for you?

In this episode of The Talking Rehab Podcast, Dr. Fred Bagares shares the real story of a patient who chose an insurance-covered orthopedic visit over direct care—and what happened next. Using the analogy of an off-the-rack suit versus a tailored fit, Dr. Bagares breaks down the hidden differences between the insurance-based model and a personalized, direct care approach.

You’ll learn:
 • How insurance companies decide what treatments they’ll approve—and why it’s not always about evidence or outcomes
 • What a typical insurance-based orthopedic visit looks like from start to finish
 • How a customized evaluation with tools like real-time ultrasound can uncover the true source of pain
• Why the hidden cost of “free” care is often lost time, delayed recovery, and missed diagnoses
• Questions to ask yourself before choosing between coverage and clarity

If you’ve ever left an appointment feeling like your treatment plan could’ve been copy-pasted from the last patient, this episode will help you see your options differently.

🎧 Listen now and subscribe so you never miss an episode that challenges conventional wisdom about orthopedic care and recovery.

Keywords: personalized orthopedic care, direct care vs insurance, orthopedic diagnosis clarity, real-time ultrasound evaluation, musculoskeletal treatment plans, patient-centered orthopedic care, insurance denial of standard of care, tailored rehabilitation plan

Transcript

0:01

Hey Doc, you seem like a really nice guy, but I can see an orthopedist for free. Why would I pay to see you? That was the exact question that Mike asked me last week, when he called to cancel his appointment. And I appreciate the honesty, but here's the thing that might surprise you. I didn't really fight to keep that particular appointment. I didn't give them my sales pitch about my credentials or what they would be missing out on. I just simply said, I completely understand. that sounds like a great plan. you know where to find me if you need anything or if you still need some help but good luck with everything. I'll make sure to follow up with you. So the question is naturally why, why didn't I necessarily push more? And that's because I already knew exactly what the visit would look like. I want to talk about why that matters, not just for Mike, but for anyone trying to get the most out of what they've already paid for. I'm Dr. Fred b Garris, and this is the Talking Rehab podcast where we challenge the conventional wisdom about recovery and healing. And today I want to talk about whether or not you need a protocol or a customized treatment plan. Quick favor, before we dive in. If this podcast has changed how you think about your body or your recovery, hit that subscribe button. It's free. It takes two seconds, and it's how we keep bringing you these conversations every week. No fluff. Just real talk about what actually works. Thanks for being here. Now let's get into it. So this wasn't really about one appointment. This was about two completely different systems of care. One system is built to move you through a process and The other is built to move you forward. And look, I get why Mike made that particular choice. He's already paying for insurance. He wants to use what he already bought. It makes perfect sense. The problem is that most people think that insurance companies are looking out for them to deliver quote unquote healthcare. They also believe that they are covering the latest and greatest treatments to help their subscribers or members get better, but. if you've been in the medical system recently or tried to get some sort of testing or treatment done. You probably have experienced it, but ask any physician who's tried to get treatments approved and they'll tell you that is completely not the case. Where they are looking at the latest and greatest, they just simply aren't. Here's what is actually happening. Insurance companies aren't just avoiding cutting edge treatments. They definitely do that, but unfortunately, they're also sometimes not covering standard of care treatments. I hear this from patients all the time. My insurance denied my radiofrequency ablation, which is a procedure for axial neck pain. They denied it because they said that there's no research to support it, and that's just simply not true. There is, decades of research on this particular topic, I can extrapolate this to injections for the knee, regenerative injections. And if you go through any specialty, any physician will say something to that effect. So it's not necessarily about evidence, they just tell you that, to essentially deny the care. but I get it. It's a business. They're trying to cut costs. The unfortunate part of that is that, physicians are only able to deliver care that they approve, which is frustrating for us. But as a patient, it also delivers a certain type of care. So let's play this out. Mike walks into an orthopedist office thinking that he is going to get a, comprehensive evaluation. But, it takes about two weeks to get in. they. Check into the waiting room, wait about 30 to 45 minutes. they get taken back into the treatment room and then have to wait another 15 to 20 minutes. And unfortunately that's just the way it goes when you go to a high volume insurance based clinic. When they're finally seen, the doctor is pleasant enough, hopefully. Yeah. unfortunately, I have to say, I have to add that in there. Hopefully they're pleasant enough, very professional, but, they have a certain amount of time and roughly it is less than 10 minutes, for face-to-face time, and that's to get everything done. So let's say they come in, they do an examination, the physician walks out, gets an x-ray, and during that period of time the physician then goes to a different patient's room. because, there's obviously very busy clinic. You get the x-ray, you come back, you wait again, and then they come back in and they look at the x-ray and say, you have a little bit of arthritis of the joint. But that's pretty normal for someone your age. Mike's thinking, so it's arthritis. Is that it? The X-ray shows I have arthritis, but could it be anything else? And usually a physician can only comment on what they can see. and if you're looking at an x-ray, you can see arthritis, you can see fractures and things like that. But that's not always the actual diagnosis. It's just what they can see. It's the image modality that's available to them in the clinic. And they are then prescribed a kind of vague diagnosis. they're referred for physical therapy, which is the right move, and then they end the visit with, if you're not better, call me back. And so that, that to me is not a great way to end a visit. But, my experience when I see people, it's definitely different. What they would get if they saw me, is I would obviously do a comprehensive examination. but I also use ultrasound into my practice, which can see elements of arthritis. But in addition to that, I can look for tendon related problems, bursitis issues, muscle problems. and I have a better picture in my mind of what is actually going on. And I have the added value of. moving the patient's, extremity. So if their pain is only present in certain positions, I can put them in that provocative position and scan them. So x-rays in my clinic aren't very useful unless I suspect a fracture. And majority of the people that are seeing me are for overuse injuries anyways. But, from there, I Detail, a very comprehensive and customized rehabilitation plan. And then I follow up with them, after they initiate the treatment that we laid out. And we can call and text and then as long as we get the rehabilitation plan moving forward, great. But if we need to eventually get more imaging, not like an x-ray, but like an MR, I can place that order. So everything is a lot more efficient, but there are clearly two different systems, two different approaches where you can see the contrast. But this is a great analogy. If you need a suit, you can certainly go to any department store and get something off the rack. it fits a lot of people, some people, that does just fine, which is great because again, for a lot of people off the rack gets the job done. However, if you have a particular body type or height or what have you, Off the rack is not good enough. You need to get a tailor. You need to get something more than the basic product, something that is suited specifically for you, and that is essentially what my practice is like. So I look at everybody as an individual. I appreciate the fact that some people need 10 minutes of care, some people need more. But more importantly, in order for me to understand you as an individual. I, and to be effective in designing your rehabilitation plan, I need more time. So that's, paramount in my practice in my particular style. again, I'm not anti insurance. However, Any business is going to try and cut costs. But from an insurance standpoint, that doesn't always equate to a patient-centered focus. You know what's actually good for the patient because just because you know a treatment is expensive doesn't mean that it's not going to work. It doesn't mean, or that, let's say that something doesn't have a lot of research behind it, or doesn't match a particular protocol, it doesn't mean that it's not the right move. But these are some of the policies that, we all sign up for when you do take insurance, or pay for insurance as a subscriber, that you're tied to. a direct care system actually approaches it from what does this person actually need to solve this problem and prevent it from happening again. And that fundamentally is a very different focus. again, getting back to my example, in the insurance based system, Mike gets a diagnosis of based off of an x-ray, which is they have arthritis, but that's not a very specific finding. and the physician themselves mentioned that this is a very common finding with time and age. So but they did get a kind of, protocol treatment plan. in my particular approach, I spend more time with the patient. I get to know them so I can design a very specific, customized rehabilitation program. But after the call, I started thinking a little bit more about the bigger issue and the issue isn't necessarily that they wanted a. Off the rack approach. They didn't want a non-specific treatment plan, but it's because, they already bought it. they bought, they paid their monthly premium. So it's like you've got a gym membership and the equipment there is adequate, doesn't do the trick, but there is a class or some sort of equipment outside of that your gym does not have that you really and you know would actually. Be better for you, but you've already paid for it. So you try and make it work. I get it. I get it. you have the equipment there. You have, a physician that participates with your insurance and so you work with what you got. I completely get that. However, the problem is the insurance company has convinced people. really all of us that they represent and cover, quote unquote good care, current care, evidence-based care, and that's, unfortunately, that's just not really the case. They deliver care that is the most cost effective for them. And unfortunately, that doesn't necessarily equate a patient-centered approach. So I ended up following up with Mike about. Three to four weeks later and said, how did the appointment go? And he was like, it was fine, the doc was pretty nice, it felt kinda rushed and I'm still not exactly sure what's going on. And I asked about, what was the diagnosis, what was the treatment plan? And they said, they said it was arthritis and they gave me a prescription for an anti-inflammatory, and then they referred to physical therapy. So I said, did you start physical therapy? And they said, they, they gave me the referral. They said they faxed it, but then, no one ever actually called me, so in a way I kinda, I've just been sitting around for three to four weeks and I feel like I wasted my time. And that's, this is a very common story that I hear, and it's a large reason why I actually end up following up with people that, are interested in my clinic, but choose to see an insurance-based physician or clinic because I wanna make sure that they get what they need. And the real cost that people don't talk about is the loss of time. and it's not just time, it's time in your life. So if you're listening to this and thinking about your own healthcare choices, here's what I want you to ask yourself. Am I choosing this because it's covered or because it's effective? Do I want the fastest path to we tried something, or do I want to actually understand and fix the problem? Am I okay with using my time inefficiently just because I've already paid for access? There's no right or wrong in terms of choosing an insurance based clinic versus a direct care clinic. but be honest about what you're choosing and why. Look, if you've ever left a doctor's office with more questions than answers, if you've ever felt like your treatment plan could have been copy pasted from the last patient, if you've ever wondered if there's something better available that your insurance just doesn't cover. You're not imagining In my practice. I skip all of that. No 15 minute time limits, no limitations on how many body parts we can talk about. No insurance company telling us what we, what I can recommend. I figure out what's actually wrong after listening to you. I prioritize same day clarity versus let's wait and see. I create a personalized treatment program versus a one size fits all approach. So getting back to Mike, they ended up seeing me six weeks later and turns out that there was a lot more to their hip pain actually was coming from their back, but that's for another, that's for another time. But, anyhow. I hope you guys enjoyed this episode. You know where to find me. Thanks again for listening.