The Claims Process
You (the insured) should always file a claims for an experienced loss. If you are unsure, file anyways. Most medical claims are handled between the provider (doctor, hospital or service) and the insurer (your insurance carrier). Any bill you receive from the provider should not be paid until your insurer has agreed to the amount listed, shown their responsibility and stated the remaining amount that you owe.
If the insurer and care provider fail to agree in their statements, contact your insurer to correct or clarify. The agreed to cost for service is typically handled by the insurer (Medicare, ACA individual, Group Health Plans) Arbitration on your behalf is usually granted to the insurer per your agreement. Always pay the insurer's stated amount of your responsibility.
If the insurer has denied the claim, or filed your claim paid and not fully compensated, file an exception with your doctor or a grievance with the carrier. If no remedy seek legal counsel.