The Orthopedic Care Value Gap

Why does the average patient spend over $1,000 on orthopedic care before ever receiving a clear diagnosis?
In this episode, Dr. Fred Bagares unpacks what he calls “the orthopedic treadmill”—a six-month cycle of copays, referrals, and vague answers that leaves patients frustrated and no closer to recovery. Through the story of Maria, a 42-year-old runner trapped in this maze, Dr. Bagares explores how insurance-based medicine often rewards volume over value—and what a clarity-first, direct-care model could look like instead.

You’ll hear how sunk costs, choice overload, and “coverage confusion” keep patients spinning their wheels—and how a more transparent, diagnostic-driven approach can shorten recovery time, improve outcomes, and restore trust.

If you’ve ever wondered whether you’re paying for access or actual answers, this episode will make you rethink the true cost of care—and why clarity shouldn’t be the most expensive part of your recovery.

🕰 Timestamps + Key Themes

[00:00] The $1,000 Question
Why most patients spend four figures before anyone explains what’s actually wrong.

[00:01:00] Maria’s Story: A Runner on the Orthopedic Treadmill
From urgent care to orthopedics to PT—six months, six copays, still no clarity.

[00:03:00] When “Good Insurance” Isn’t Good Care
Coverage vs. quality, and why “in-network” often means “out-of-answers.”

[00:05:00] The Psychology of Staying Stuck
How sunk-cost bias and the burden of choice keep patients cycling through the system.

[00:06:00] The Coupon Illusion
How insurance behaves like a coupon that only works after you overspend.

[00:07:00] What Value-Based Care Could Look Like
A side-by-side comparison: traditional care vs. a direct, clarity-driven model.

[00:09:00] Maria’s Turning Point
How a clear diagnosis and coordinated plan restored her confidence—and her miles.

[00:10:00] Access vs. Answers
Why clarity, continuity, and communication are the real currencies of modern care.

[00:11:00] The Reframe
Coverage doesn’t equal care. Access doesn’t equal outcomes. You deserve better.

🎧 Listen if:
You’re tired of waiting months for results, confused by your MRI report, or wondering if the system is working for you or on you.

👉 CTA:
If you want Clarity Guides, next-step tools, or to explore advanced treatments like PRP or shockwave therapy, visit FredBagares.com or MSKDirectVB.com.

Transcript

0:00

Why does the average patient spend over a thousand dollars on orthopedic care before ever receiving a clear diagnosis? I know that sounds designed to make you angry, but the real question isn't about the money. It's about what that money is actually buying, or more precisely what it's not. Today we're walking through the patient's journey when you have an orthopedic injury and by the end. I want you to ask yourself, what am I really paying for? I'm Dr. Fred Begar and this is The Talking Rehab Podcast. Before we dive in, if this show has ever made you see your body or your recovery in a new way, hit that subscribe button. It's free, it's quick, and it tells me these conversations matter to you. Thanks for being a part of this movement. Now let's get into it. Let me tell you about Maria. She's a 42-year-old marathon runner. She has knee pain that absolutely will not quit. It's not horrible, but it's just the kind that makes you hesitate before every step. Initially, she went to an urgent care. She had a$40 copay, about five minutes with the provider, was told to take some ibuprofen and to quote unquote give it Two weeks. Two weeks later she followed up because she continued to have pain and saw her primary care physician. She paid another copay and she was eventually referred to see orthopedic surgery. Three weeks goes by, she finally sees the specialist, which again is another copay. They order some x-rays, but she mentions that she already had the x-rays at the urgent care, but unfortunately, they were not able to see those x-rays and that the new x-rays needed to be in our quote, unquote in our system. Ultimately, the x-rays looked the same, which were fine, and she was instructed to try PT first. She went to physical therapy twice a week. That's$20 copays each time. She had a total of 12 sessions. The therapist was good, but seeing four patients at once, Maria was getting about 10 to 15 minutes of hands on time per visit. Yes, six weeks in,$700 spent. The pain is better, some days, but worse on others. But no one really knows why. The physical therapist recommends that she return to follow up with her orthopedist. So she went back and saw her orthopedic surgeon who ultimately ordered an MRI. Again, there was a delay to the referral due to prior authorization. It took a little bit of back and forth with imaging center and the orthopedic office, and ultimately it was finally scheduled several weeks later. However, she had to put$400 towards her deductible to obtain the MRI. Finally, she completed it and the results took approximately 10 to 14 days for it to finally be read. She had to schedule a follow-up with her orthopedic surgeon, again, another copay who reviews it in about 10 seconds. They say some degenerative change, nothing surgical, keep doing pt. But come back in three months if it's still there. Now$1,400 three months later, and Maria still doesn't know what's wrong with her knee or what to do about it. The thing that gets me is that Maria has quote unquote good insurance. She followed every rule and the system taught her one lesson. Clearly access to care is not the same thing as quality. There's a moment in almost every patient's journey when they stop trusting the system and they start questioning everything. For Maria, it came three months later at that follow-up. How's the knee? The surgeon asked, she paused. Thought about the missed work, the skip braces, the exercise that sometimes helped, but sometimes didn't. And ultimately she didn't have an explanation why. Why am I still in pain if I've done everything you told me to? The surgeon looked uncomfortable. These things take time. Conservative management is the standard of care, but I've been conservatively managing for six months. I still don't know what's actually going on. Here's what Marie was really asking. Why does having insurance mean I have to wait so long to. Ultimately get better. She learned that coverage doesn't equal care, that being covered doesn't necessarily mean you've been approved for treatment, she had learned that coverage doesn't actually equal quality care. She also learned that when something is covered, it doesn't necessarily mean that it's approved quickly. During our examination, I was watching her deflate. After months and months of trying, I could tell that she was ultimately getting angry, not at the surgeon or the physical therapist. They're good people working inside a system that was designed for billing and coding and non-patient care. She was angry at a system that charges people repeatedly for the chance to get better, but rarely commits to actually getting them there. Let's talk about what Maria really paid. Yes. She spent close to$2,000 out of pocket, but her family's insurance premium just over$26,000 a year. Think about that. She's prepaying for access to a system that made her jump through six months of hoops before anyone even tried to create a comprehensive plan. But here's the thing about costs. The obvious ones aren't usually the most expensive ones. There's a concept in behavioral economics called the sunk cost fallacy. It's the reason you keep watching a terrible movie because you've already invested an hour. You've already paid, so you might as well keep watching. Maria experienced the healthcare version of this. I've already spent so much time and money in the system. If I leave now, was it all for nothing? So she stayed. She kept cycling through the co-pay, kept hoping the next appointment would be the one that finally made sense of everything. And there's another bias here at play. There's the burden of choice. Should she find a different physical therapist, a different orthopedic surgeon? Maybe get a second or third opinion. Maybe she should try acupuncture. Every option requires another decision, another leap of faith, another chunk of money with no guarantee of outcomes. The system doesn't drain just your pocket, but. Also your mental bandwidth. Think of it this way, your insurance is like a coupon you pay for every month, but it only works after you spend enough money to unlock it, and even then, it doesn't promise to get you where you're trying to go. It just promises to pay for certain things on the way there. Here's what really struck me about Marie's journey. By about the six months, she wasn't even asking for a cure she just wanted someone to tell her clearly and honestly what was happening in her knee and what her realistic options were. She wanted clarity, and somehow in a system with MRIs and specialists and cutting edge technology, clarity was not guaranteed. And the hardest thing to find. So what would Maria's journey look like if we designed it around value instead of volume? Let me paint you a different picture. Let's assume it's the same knee problem she presents to my clinic within 90 minutes. She has a comprehensive physical examination, diagnostic ultrasound, and an actual conversation about what's going on. Not the typical one-sided conversation where the physician has one hand on the door handle already, but an actual discussion about how her knee affects her life. What does she need to do to get back to her previous level of activity and what her timeline means to her? If we need an MRI, we should schedule it that week, and when the results come back, we review them together, not in 90 seconds. We take the time to connect the images to her story, to show her what we're seeing and why it matters. Then we build a game plan, not just your generic 12 session PT protocol, a personalized approach designed around her performance goals. Maybe that includes physical therapy. Maybe it includes regenerative treatments like PRP or shockwave. Maybe it's a combination, but here's the critical part. There's no gatekeeping, no waiting weeks for follow-ups. No resetting the clock every time she sees a different provider. One narrative, one goal. Is this more expensive upfront than a copay? Sometimes, yes. But here's what I've learned. After years of practicing both inside and outside the traditional insurance model, cost and value are not the same thing. Maria spent$2,000 to stay confused for six months. What if she could spend that same amount or maybe even a little bit more to get clarity, continuity, and her life back in six to eight weeks? What if the value of care wasn't measured in visits, but in how quickly your life gets back on track? That's not a hypothetical. That's the question we should be asking every single time someone enters the healthcare system. Let me tell you how Maria's story actually ended after six months in the insurance maze, she found her way to me. She found her way to my practice. Within two weeks, she had a clear diagnosis and we designed a comprehensive rehabilitation plan around proprioception, tendon loading, and regenerative medicine to avoid surgery. Eight weeks later, she was back running, not perfectly, not without some adjustments to her training, but at least she was back to running. And when I asked her what the biggest difference was, she didn't talk about the treatment, she talked about the clarity she now has in her overall game plan. For the first time someone told me what was actually wrong and what we are going to do about it. I could make decisions, I could plan. I wasn't just waiting for the system to give me permission to get better. This isn't about rejecting insurance or pretending the traditional system doesn't serve a purpose. It absolutely does. For acute traumas, emergencies, unexpected surgeries, insurance is essential. But for the vast majority of orthopedic and musculoskeletal care, the system isn't optimized for what patients actually need. And maybe it's time we stop pretending it is. The orthopedic journey doesn't need to be this hard. You've already been investing in premiums and time and hope. The question isn't whether you can afford to invest more. The question is whether your current investment is actually paying you back. So I'll ask you again, what are you actually paying for? Are you paying for access or are you paying for answers? Are you paying for coverage or are you paying for care? Because here's what I've come to believe. After years of watching patients navigate this system, clarity shouldn't be the most expensive part of your care and momentum. Getting your life back shouldn't require you to jump through so many hoops You deserve a better orthopedic patient journey. Just some food for thought. If you want Clarity Guides, next step tools, or to explore advanced treatments like PRP or Shockwave, visit fred biggar.com or MSK direct vb.com. Until next time, take care of yourself and demand the care that you deserve. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.