Where in the ACA is the section that talks about emergency visits to hospitals and when an out-of-network doctor provides care to a patient. I recently had emergency surgery and i was provided care by an a out-of-network doctor. I want to appeal my health insurance’s decision not to pay this doctor because the doctor is out-of-network.
Out-of-network emergency care is covered under all insurance plans sold after March 23rd, 2010 as part of Ten Essential Benefits under the Affordable Care Act.
Insurance plans can't require higher copayments or coinsurance if you get emergency care out-of-network and they cannot require prior approval either. All non-emergency care must be done in-network to be covered and may require prior approval.
If your insurer is trying to bill you for the care you may have to appeal their decision.
If you get any care that is not strictly emergency care, out-of-network rates may apply. So always be very careful with this and make sure you are communicating with your insurance provider so you don't get blindsided by extra costs. Some plans will have a separate out-of-pocket maximum and deductible, so keep that in mind too.
This information can be verified at HealthCare.Gov or can be found in Sec. 1302. of the Patient Protection and Affordable Care Act. You may want to check out our page on Ten Essential benefits for further reading.