So, S. Mart rides his bike to work. Everyday.
BOOM! A car smashes into S. and he's whisked to the local emergency room by ambulance. S. had no CHOICE as to the ER since, um, well, HE JUST GOT HIT BY A CAR!!!!!!!!
His group insurance carrier informed him that since the hospital was Out-of-Network, he'll have to pay the difference. (This typically doubles to quadruples your out of pocket...)
Technically, since it was an emergency, and S. had no choice, the out-of-network rates should not be applied. In fact, the carrier did agree, and is reviewing the submitted bills from the hospital. Good on them.
Here's the Stupid Broker Trick: Selling a group plan where the Area's MAJOR ER was Out-of-Network. "I'll bet it was the cheapest," interjected my friend in HR, KRE. So, this guy made the sale, but failed to inform a rather key piece of info.