Tuesday Apr 08, 2025

167. Exposing the Myths: Health Insurance Lies & the Problem with Cookie-Cutter Healthcare

Using insurance for physical therapy might feel like a smart move until you see the price you’re paying in time, money, and results.

When Dr. Andrew Fix sat in on a client’s post-op appointment, he didn’t expect the orthopedic surgeon to describe their own physical therapy department as “a factory.” But that offhand comment revealed something bigger: a system that’s become overloaded, rushed, and driven by insurance reimbursement instead of patient outcomes. So why are so many people still choosing in-network care? And what are they actually getting for their money?

In this episode, Dr. Fix breaks down how insurance is shaping the way physical therapy is delivered and how those choices affect real people. He explains why high-volume clinics are the norm, how reimbursement cuts are pushing providers to see more patients in less time, and why many people end up with surprise bills despite thinking their care is “covered.”

This is a conversation about time, trust, and the true cost of healthcare. If you’ve ever felt confused by your insurance or unsure whether cash-pay care is worth it, this episode gives you a clearer way to think about your options.

Quotes

“The clinic is so crowded with clients and the schedule of the therapist is so full with people every day that the clients don't get a very personalized and individualized experience.” (03:48 | Dr. Andrew Fix)
“The orthopedic office has their own physical therapy department, but the physicians, because they don’t like the quality of the experience that clients are receiving downstairs... they’re choosing to refer their clients elsewhere, where it takes money out of their practice’s pocket.” (04:46 | Dr. Andrew Fix)
“Every year, we as consumers, you as consumers, pay more for health insurance... but then, every year, it seems like your insurance is covering less and less and less.” (06:19 | Dr. Andrew Fix)
“I can absolutely promise you that it is not necessarily cheaper to go to an in-network place versus an out-of-network or cash pay style office.” (10:01 | Dr. Andrew Fix)
“We get to spend so much more time with the client that we can oftentimes achieve the same or typically a better outcome in a fewer number of sessions... you get back that one finite resource that none of us have enough of, and that’s time.” (14:04 | Dr. Andrew Fix)

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