they make things worse, however, when it comes to emergency care, it seems that insurance companies should be required to pay out of network hospitals and doctors either the same rate they pay their own doctors, or some set minimum percentage - in the case of emergency only.

Then the ER doctors/hospitals should be required to take those payments as paid in full.

This way, people will always be able to know in the case of an emergency, their insurance will be the same and they can focus first and foremost on the care needed, not whether they should ask the ambulance to go to a further hospital because they are in-network.

Then, the ER docs would get paid at least something in these cases, most likely an amount similar to what they already get, and the insurance companies are not forced to pay any more than they are already paying for these same emergencies at their own hospitals.