Her is an example of how my employer provided - yet still expensive insurance works. We have met our deductible (we must each pay the first $500 of expenses.) This doctor submitted a charge of $104.27. Cigna discounts that to $64.97. Coverage is 80% so Cigna pays $51.98. I am responsible for $12.99.

Who pays the $39.30 between what the doctor charged and what Cigna and I paid?

Don't know. I could be cynical and say the doctor's charge was higher knowing there would be a +60% discount applied but I don't know that.

But the situation Grace described with her diabetes supplies is the standard operating procedure of PPO coverage.