Donna: The amount of copay and the amount or even if the doctor can bill a patient for charges not covered by insurance is determined by the contract the physician has with the PPO. Some stipulate that the co-pay is all the doctor can get from the patient. Some do not. This should have been investigated prior to your surgery and I think the dotor's office has an obligation to iron this out with you beforehand. However, the consumer also has a responsibility here. Managed care is not always the deal it looks to be on non-routine types of care. I encourage all consumers to look at their policies very carefully and not assume that the third party payer will "take care of it". this is the attitude that has, in part, gotten us in to trouble. For those of you who have a choice of third party payers, compare policies. You may end up getting better coverage, and better care if you stay with an indemnity plan (they pay 80%, you pay 20%) rather than a managed care plan (PPN, PPO, HMO, etc.) And my soapbox is: We are spoiled in this country (US). We expect the best, and we expect it now, but we want someone else to pay for it. Because we have given up our rights to make our own health-care descisions and now refuse to take more responsibility, we have a healthcare crisis that is threatening quality of care in the name of cost containment. The solution to this dilemma is to empower the consumer to take more responsibilty both for there bill and for their health. Prevention is the name of the game and so is competition (more competition for docs, more advanced practice nurses, more allied professionals, more nurse-midwives, greater use of alternatives that are proven effective, etc.) But if we want quality and less expense, we, as the consumer, are going to have to demand it and we are going to have to pay for it more. Breastfeeding is a perfect example of cost containment from greater consumer responsibility and fits into the prevention model. Alison, TPR Chair who had to do lots of research and didn't like what she found out.