OON Prepayment + Courtesy Billing… Double Dipping??

I had a consultation (2 appointments) with an OON knee surgeon in NYC, who required I prepay his $475 fee and the office took my insurance information and said they would bill my insurance for me and refund the rest. They said they did this because they’re OON, they want guaranteed payment, and they don’t know if my insurance will pay the whole amount, so they don’t have to accidentally work for free while trying to track down patients to pay.

Now, they’re saying they’re “out of network which means we don’t take insurance” and I paid $475 as the fee for the consultation and that I can file a claim myself to get reimbursed from my insurance, that they don’t take insurance.

What was incredible was 30 seconds later she was explaining that my second appointment (where he told me my MRI results) wasn’t something they charged patients for and instead just billed insurance (could not make this up). Office received a $90 payment from insurance.

Got into this whole argument when I was calling to clear up a billing issue (first appointment that I prepaid $475 for needs to be resent), but now they have me stressed out. Will they need to refund me any payment received from insurance? I am pretty sure I can’t file for reimbursement for a visit a provider has billed for!?

My understanding is: Dr wants $475, I pay $475, they bill my insurance $1230 (I don’t know why, apparently just to maximize insurance benefits and amount paid to them?). Then, basically two situations (essentially) can occur:

Insurance pays them $1000, office needs to refund me $475, office keeps additional $525. Doctor’s office now has a total of $1000 for their $475 appointment and $0 from me due to crazy insurance coverage.

Insurance pays them $200, office needs to refund me $200. Doctor’s office now has a total of $475 for their $475 appointment, just $200 came from insurance and $275 paid by me.

If they refuse to pay me back, wouldn’t they be double dipping? Getting insurance money and then my $475 from me?

Is any of this allowed? Is this typical? This is how it works with other surgeons. If they refuse to pay me, can I even go to my insurance to get the office to pay me? Especially if they’re saying it’s an appointment that’s $1230 (not disclosed they would bill that much at time of appointment), if insurance only pays them something like $200, then will insurance care if they’re saying I owe them $1030 now?!

(For reference, I got my surgery done elsewhere OON. The surgeon’s fee was 10k. I prepaid 5k, office billed insurance. After surgeon received at least 10k from insurance, I got my 5k back. If insurance didn’t cover at least 10k, I was responsible for it, with 5k prepayment going towards that. In the end, insurance paid 30k, I got my 5k back, and surgeon kept an additional 20k from insurance).