Here, because we are a provider for BCBS, we are not allowed to demand payment up front for services. It seems like if they asked for money up front, then perhaps they are not a "Preferred Provider" with the local PPO or not on the HMO option. This may be the reason for the discrepancy in the billed amount. You see, we have a flat rate that we bill, say $150 for an office visit. Because we are a Preferred Provider with BCBS, our agreement with them means that BCBS patients only have to pay at the "Allowed Amount" of the negotiated fee schedule which figures out to be about 54% percent of charges or about $80. That number only applies to BCBS patients though. When an Out-of-Network patient is seen, they are responsible for any amount over what their insurance company determines is "reasonable and customary". It may be that BCBS determined that $3100 was their fee schedule amount for this surgery and they are only paying the patient a percentage after deductibles/copay/coinsurance; hence the low payment amount.

I know it's bloody confusing, but I deal with it everyday.

Also, "Salacious Crumbs" is the best tag ever.