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If you pay the provider directly, insurance company won’t know about the payment.
If you pay provider via insurance company site, 3rd party service provider pays it out.
Context: I rarely use my insurance until I had an emergency surgery. The payment system seemed straightforward until the providers got involved directly with me. That’s when I realized the gap.
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The idea is that you pay the provider upfront with a copay. Provider then sends the bill - copay to the payer and they send back a negotiated rate (this could mean you’re on the hook for the full amount if you have a high deductible plan).
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A blockchain payment network was proposed to help fix this.