When you visit a doctor seeking treatment, the price/value for the service that is rendered is established by the insurance company, and the insurance company will pay for that service up to the amount that they have established. If the doctor charges higher than this amount, the insured must pay the difference. If it is less, the insured would get a discount, and may pay less for that service. Each insurance company establishes what types of visits are covered at 100%, 80%, 50%, etc., in your initial policy.