I had a total knee replacement in July 2015. I questioned the PA about one of the charges for his services that the HC Insurer rejected. I didn't want him to not get paid. And we then had a conversation about the "billed" costs, vs. the HC Insurer's "negotiated" discounts, and the balance that would is left to the patient. It seems that Drs routinely charge a fee that is bust-out-MSRP for each procedure. They know the HC Insurers will trim it down - and that's okay with them. The reason they automatically charge the bust-out MSRP prices is because that's the amount that Accident insurances pay, and the amount that Worker's Compensation pay. Those cases are gravy for them. And, because the HC Insurers can show their clients that they "negotiated" much lower rates, their client - the patient is generally happy because they're left paying a nickel on the dollar of those bust-out MSRP charges.