Many procedures have bills from multiple sources, as you described. Basically do not worry about the source of the bill, just add up what you actually paid. Whatever insurance did not cover you paid for "out of pocket". If you paid - it is an expense and you add it all up together. Premiums are what you pay to insurance companies, including for Medicare and "Medi-gap" premiums. Premiums are not medical expenses, however some premiums, such as if you are self-employed or pay for long term care insurance, are deductible.
