[Noah930]

...

Lots of issues involved here: provider networks, variations in individual contracts, balance billing, customary/regional billing practices, and plain old ethics.

Insured People will often pick primary providers within their network, for obvious financial considerations. But it gets complicated when a team approach is necessary for care. You may pick an internist or surgeon partially I based upon whether or not they're within network, but what happens when you need a lab, or x-rays, an anesthesiologist, or a facility like a hospital or surgery center? Sometimes it's like getting planets to align, finding a surgeon, a lab, a radiologist, a pathologist, a surgery center, and an anesthesiologist all within your network. If any of those planets don't align, you stand the proposition of a billing surprise. And even in my limited career-span, I have seen that getting worse with time, not better. These were trends that started even before Obamacare, though Obamacare may have hastened this progression, IMO.

And there seem to be certain specialties that are frequently out-of-network: ER docs, anesthesiologists, radiologists, and pathologists. Locally, even hospitals (as in, the physical plant of the hospital itself and the ER) are terminating contracts with insurers. It's hard to negotiate or shop around for a better deal when you're lying on your back in distress on a gurney.