What will joint care cost, and what will insurance pay?

Why aren't two clinic prices the same?

One clinic may quote only the first procedure, while another includes later checks. Clinics may also prepare the blood in different ways. A payment plan can lower the monthly bill, but it doesn't reduce the full amount owed.

Ask the clinic to name the procedure and say plainly whether it uses your blood or something else. The written price needs every fee and each included visit. It also needs to explain what happens to the price if the exam leads to different care.

If the clinic won't explain the charges, don't agree to pay yet.

What exactly should I ask Medicare or my insurer?

Medicare does not broadly cover PRP for a sore joint. Other plans may also refuse payment for procedures based on your blood. Have the clinic write the procedure's full name on paper. Read it to Medicare or your insurer, then ask whether your policy pays any part of the procedure and whether approval is required before the clinic provides it for you.

Write down the date, who answered, and any call number you receive. Travel and later appointments may add costs that insurance does not pay.

A payment plan is still your debt; it isn't insurance coverage.

What belongs on the written price?

The paper needs the joint being examined, the planned care, every clinic fee, and follow-up visits. It also needs the rules for getting prepaid money back if you cancel. Ask when the clinic will check whether your soreness or movement has changed.

Once the joint is examined, QC Kinetix can discuss biologic therapies, meaning procedures made with blood drawn and prepared for you. Compare the price with exercise, medicine, and alternatives to knee or hip surgery.

Choose the care on its likely benefit and limits, then consider the bill.

Sources

1. A cross-sectional study contacted 273 of 317 US centres offering direct-to-consumer stem-cell therapy, posing as a 57-year-old man with knee osteoarthritis. The mean advertised price of a unilateral same-day stem-cell knee injection was $5,156 (SD $2,446), and centres claimed a mean clinical efficacy of 82% (SD 9.6%) - a figure with no support in the published evidence. The gap between the quoted number and the trial data is the single most useful thing a patient can be told before a consultation.

   Piuzzi NS, et al. — The Stem-Cell Market for the Treatment of Knee Osteoarthritis: A Patient Perspective.. The journal of knee surgery, 2018. DOI: 10.1055/s-0037-1604443.

2. Medicare's National Coverage Determination covers autologous platelet-rich plasma ONLY for chronic non-healing diabetic, pressure or venous WOUNDS, and only under Coverage with Evidence Development inside an approved clinical research study. There is no Medicare coverage pathway for PRP as a treatment for osteoarthritis or any other joint indication, which is why these injections are quoted as cash prices.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS.gov, 2012.

3. In January 2025 the Federal Trade Commission banned the co-founders of a stem cell institute and their companies from marketing stem cell treatments and ordered them to pay more than $5.1 million in refunds and civil penalties. Deceptive EFFICACY ADVERTISING, not merely unapproved manufacturing, is independently actionable - the FTC polices what a clinic promises as well as what it injects.

   US Federal Trade Commission — Stem Cell Institute Co-Founders and Companies Banned from Marketing Stem Cell Treatments and Ordered to Pay More Than $5.1 Million for Refunds and Civil Penalties. FTC Press Release, 2025.

4. The study that first mapped the scale of the US direct-to-consumer stem cell industry, finding widespread internet marketing of unapproved stem cell interventions by businesses based in the UNITED STATES - previously assumed to be a phenomenon of countries with lax medical regulation - and concluding that regulators must better oversee this marketplace.

   Turner L, et al. — Selling Stem Cells in the USA: Assessing the Direct-to-Consumer Industry.. Cell stem cell, 2016. DOI: 10.1016/j.stem.2016.06.007.

5. Roughly 14 million people in the United States have symptomatic knee osteoarthritis, and more than half of them are under 65 - with nearly 2 million under 45. The market for a cash-pay procedure sold as an alternative to joint replacement is largely working-age people who are being told they are too young for surgery.

   Deshpande BR, et al. — Number of Persons With Symptomatic Knee Osteoarthritis in the US: Impact of Race and Ethnicity, Age, Sex, and Obesity.. Arthritis care & research, 2016. DOI: 10.1002/acr.22897.