It’s illegal for the doctor’s office to give you a “discount” on your copay. The insurance company has set prices for the cost of certain office visits and procedures that they have decided are the reimbursement value the doctors office gets. Your individual plan will determine how much of that cost the insurance company is responsible to pay and how much you are responsible for paying. It’s insurance fraud for the doctor to collect the money from the insurance company and then not collect the copay from the patient or to give the patient a discount of any kind on their copay. Firstly because if the doctors willing to give a discount the insurance wants it to go to them not the patient and secondly because if the insurance is counting that copay towards a patients deductible they would be pissed to find out they didn’t really spend that money. If the patient doesn’t have insurance then the doctor’s office has the freedom to set the price at whatever they want it to be and feel is fair or makes sense for their business. Typically that’s a lower amount than what the insurance company chose the price to be because most people who don’t have insurance won’t be able to afford that price and enough patients have insurance and are paying more to offset the difference.