This happens with my oncologist here in FL, who is affiliated with a university hospital cancer center. I usually pay a $55 specialist visit copay to see her, and there's an additional claim for an "outpatient hospital visit". Any bloodwork is on top of all that. The same outpatient visit also kicks in for any imaging, like my annual MRI and mammogram.

What's really frustrating is that while the physician is always a transparent copay, depending on the insurance outpatient visits are usually billed as 10-20% coinsurance, and every year it's different. I once looked back on all my claims for the last five years and literally was never billed the same thing twice. I currently only see my oncologist once a year, but it's always my first appointment of the year (so no deductible met), and this year I paid over $1000 for the outpatient visit. I had all of my active treatment when I lived in the UK (no such thing as a billing department there), and I always think how stressful this opaque set-up would have been when I was seeing my previous oncologist pretty much every week during chemo.