When I first began practicing medicine, discussing finances and insurance with patients was often considered taboo. Today, that approach no longer serves patients well. Transparency, integrity, and education are now essential parts of high-quality medical care. As physicians, it is our responsibility to help patients understand both the benefits and limitations of health insurance so they can make informed decisions about their health.
Reframing How We Think About Health Insurance
One of the most important mindset shifts we can make is to think of health insurance similarly to car insurance. Car insurance is designed to protect you in the event of a major accident or crisis. It is not meant to cover routine maintenance, oil changes, or standard wear and tear.
Health insurance functions much the same way. It is most effective for:
Emergency room visits
Hospitalizations
Major surgical procedures
Serious or complex illnesses such as cancer
Expecting insurance to fully cover every diagnostic test, treatment, or preventive intervention is increasingly unrealistic in today’s healthcare environment.
The Reality of Insurance Decision-Making
Most private health insurance companies are for-profit businesses. Their primary objective is financial sustainability and profitability. While patient health may benefit along the way, insurance companies are not staffed by physicians who treat patients daily, nor are they deeply involved in interpreting evolving medical research in real-world clinical settings.
Government-sponsored plans, including Medicare and Medicare Advantage plans, often operate with similar limitations. While they are not structured as profit-driven entities, coverage decisions are still made through large bureaucratic systems that may not prioritize individualized care.
Why the Physician–Patient Relationship Matters More Than Ever
Over time, meaningful medical decision-making has gradually shifted away from the physician–patient relationship and toward insurance-driven approval processes. This has created the false assumption that if a treatment is covered, it must be the best option — and if it is not covered, it must not be effective.
That assumption is simply not true.
The highest-quality medical care occurs when physicians and patients work together as a team, customizing diagnostic and treatment plans based on the patient’s goals, values, and the best available medical evidence — not solely on insurance coverage.
A Common Orthopedic Example
In orthopedics, this issue arises frequently. For example, insurance companies will often continue to cover repeated steroid (cortisone) injections for knee osteoarthritis — even when excessive use can accelerate joint damage and worsen long-term outcomes.
At the same time, many insurance plans still label platelet-rich plasma (PRP) injections as “experimental,” despite more than 50 clinical studies demonstrating its effectiveness in treating knee osteoarthritis. Interventional orthopedic physicians are increasingly advocating for PRP to become a standard of care, as it addresses inflammation and joint health rather than temporarily masking symptoms.
Preparing Financially for Healthcare in 2026 and Beyond
With rising deductibles and limited coverage for many advanced diagnostics and treatments, patients should expect to allocate some funds for out-of-pocket healthcare expenses.
Just as you pay an auto insurance premium yet still cover routine maintenance and repairs, healthcare now requires a similar approach. Unlike vehicles, our bodies do not come with warranties.
As we move into 2026 and beyond, the most important step patients can take is to work closely with trusted physicians who prioritize your long-term health — even when insurance companies are not aligned with those decisions.
Some specialty medical practices see you as a “knee,” an “ankle,” a “hip replacement,” or “that person with too many aches and pains.” At Impact, we see you as a whole person. We see you from head to toe and do our best to advise you on long-term lifestyle choices to keep you, your joints and soft tissues as healthy as possible.
Here are our current 5 best pieces of advice for you:
1) Use food to your advantage, not as a detriment: many think only of food as calories, but instead, let food be nutrition…something that can nourish your body. Choose wisely with lean meats, some plant-based protein sources, numerous fruits and vegetables and healthy fats. Really limit fried foods, fast foods, processed foods, foods high in sugars and artificial sweeteners. Don’t forget about healthy beverage choices: more water than anything, adding green tea or black coffee but keep soda and alcohol very much in moderation. Why is this important? Proper nutrition allows for healing and recovery. Poor food and beverage choices lead to more inflammation and pain.
2) Being at a healthy weight is very important for your joints and soft tissues: every 1 pound someone is overweight equals 4 pounds of extra force going through his/her lower body joints. On the positive side, you lose 10 pounds, you have 40 fewer pounds of force on your knees and other joints. Osteoarthritis of the hips and knees, plantar fasciitis and insertional Achilles tendonitis are the most common conditions we see in overweight individuals.
3) Make cost-effective medical decisions: did you know that seeing a physician employed by a hospital or one associated with a larger group practice is more expensive than seeing a physician in a smaller private practice? Why is this? It is because insurance companies and these larger organizations have negotiated higher reimbursement rates. Is this based on a higher quality care? Absolutely not! It’s just the behind-the-scenes business of medical economics, and not many patients are aware of this. An office visit at “Hospital/Large Practice X” may cost you $300. A similar and possibly even more comprehensive visit at our practice may cost you $200.
4) Stay moving, as “motion is lotion”: whether your knee or low back hurts, or you are just stiff quite often, staying mobile will help your musculoskeletal system. Don’t sit for too long. Don’t keep your hips, knees or spine in one position for too long. Set a goal for a certain number of steps each day, even if you are not classifying this as formal exercise. Walk while you talk on the phone. Choose an adjustable or standing desk if possible.
5) Find your sweet spot when it comes to exercise and activity: perhaps 2 miles of walking is too much for your arthritic knee, but 1.5 miles feels good, both during and after the walk. 25 minutes of the bike is great, 30 minutes creates pain. 2 sets of bench press with 30 pound dumbbells feels right, but 3 sets with 40 pounds causes shoulder pain. “Sweet spot” exercise is essential, especially for us middle-agers and older.
As always, let us know if we can be of assistance to you!
Time:we’re all so busy, at least we think we are. Let’s be real, going to see the doctor does take time. Driving, parking, filling out forms, waiting, talking, testing and deciding. The average visit from start to finish. meaning door-to-door is in the range of 2 to 3 hours. Yet, that 2 to 3 hours could be the difference in you getting a diagnosis, relieving anxiety, feeling better, promoting better function and doing something that can help your body long-term. Are you willing to binge watch a show for 2 to 3 hours? Are you willing to go to dinner for 2 to 3 hours? Are you willing to surf social media and watch videos for 2 to 3 hours? Are you willing to go to the mall for 2 to 3 hours? Are you willing to go to the gym for 2 to 3 hours? If the answer to these questions is “yes,” then you definitely have time for a doctor’s visit.
Fear: so many patients skip that doctor’s visit because of fear of a frightening diagnosis, a recommendation that surgery is necessary or because of potential expenses that come with that visit and subsequent treatment. Here’s the good news: often that fear fades away once you get into the doctor’s office and actually are able to learn why you have certain symptoms and then are able to develop a plan of action. I’ve seen it for decades, as many patients, even when given news that they did not want to hear, find a sense of relief. Frequently though, we are able to provide good news and reassurance, calming the patient’s fears. In a nutshell, fear of the unknown is often much greater than the fear of the known. More good news here… 95% of patients that present to our office do not require surgery!
Money: sometimes the most expensive course of medical treatment is the one that was developed late in the game. Meaning, if a patient would have sought treatment earlier, a much less expensive plan of action could have been developed. There is no greater investment than the one in your health. We are all willing to spend money on trips, hobbies, clothes, restaurants, cars, etc. While all these can have value, they don’t hold a candle when compared to your health. So, make sure that you are budgeting enough money to pay for your necessary healthcare. Finally, when making financial decisions about your health, attempt to think long-term, not just short-term.
As always, let us know if we can be of assistance to you!
