The other reason doctors and hospitals go out of network is that they can then make any deal they want with the patient. They CAN just take the OON amount from the insurance company. If the IC pays 80% of U&C it's MUCH more than the contracted rate so the provider comes out ahead, and the patient will come back. The provider can balance bill, but they should use the OON as a bargaining chip whenever possible. It's good for business. One of our local hospitals stopped all their contracts with insurance companies. There business is still good because they can negotiate with the patients. I've only heard good things so far, but I've definitely been listening for the complaints.
The U&C is considerably more. Is the anesthesiologist LEGALLY OBLIGATED to collect the difference, or can they accept the allowed amount for a participating provider since everyone else involved in the procedure was in network, and the patient was not informed that they were out of network?