there should be no excuse for this type of thing. The hospital computers should be able to tell immediately when the patients insurance is entered in if there is an out of network issuewith their coverage and the ER physician. It sucks for the doctors that there is anger directed at them, it really does. They're just doing their job. Still, the three parties involved are in some way responsible for this at varying levels: the insurance companies, the hospitals and the physicians groups. Someone should be able and responsible to warn the patient at the time of services provided that there will be additional charges. It's hard to say that the patient is responsible when their primary concern is getting emergency treatment. Billing is the last thing on my mind in the ER.