| My insurance plan pays a contracted rate with all of my healthcare providers, regardless of the billed amount. It is a PPO plan that allows me to use any doctor without referrals, the cost of which to me is 20% of the contracted rate. Since 20% can be a substantial amount in the healthcare business, I use a secondary insurance to cover it.
My first endo visit was billed at $200 for the office portion of the visit, insurance paid $170. Follow-up visits have ranged for $65 to $115, with the insurance contracted rate being about 80% of the total. With the two insurances I only pay deductibles (capped at $900 per year per family).
If I were to choose the HMO plan, I would only be responsible for the copay, $12 per visit, and would not require the secondary insurance. But all visits to any doctor except my PCP would have to be on a referral basis. Any visit while out of town to any healthcare provider would have to be approved in advance or within 24 hours of an ER discharge. | 
