[aamar]

See here[1] for a pretty good explanation. Importantly, your insurer treating the visit as in-network does not force the provider to treat it as in-network; surprise bills come from the provider, not the insurer. From that post:

If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts you pay.

That “if” condition is usually going to hold, so a lot of surprise bills come out even despite the ACA rule.

[1] https://www.verywellhealth.com/get-in-network-rates-out-of-n...

[normaljoe]

And this still happens in Texas where it is suppose to be illegal as well. I called provider multiple times and explained the rate from my insurer. They of course sent to collections, but they know they can't enforce it in court, but that doesn't matter. Most people are just going to pay.

What really got to me was it was ER visit and the Doc(extortionist) spent maybe 5 minutes with me before having the nurse fix me up. After insurance $250 to hospital, and $2000 bill for the Doc.