How much does a cable/satellite provider have to pay?

My PPO is refusing to pay half the cost of emergency care by a non-participating provider. Is this legal in CA?

• On my list of benefits, they say that non-participating provider emergency room is covered 100%, emergency physician is covered 100%, and emergency copay is "shared with participating physician." I received an explanation of benefits the other day stating that they paid like $350 and I would be expected to pay the rest, like $450. Their reasoning was that they paid 100% of what they would have paid to a preferred provider. Which almost makes sense, if I had any control over getting a preferred provider in the first place. I asked them where I should go or what I should do in an emergency situation to insure that I'm receiving care from a preferred provider. They had no suggestions other than make sure you don't use emergency care unless you have an emergency. I felt it was an emergency. I'm frustrated because medicare people have a cap on how much extra they can be billed. According to what the insurance company is telling me, I'm playing russian roulette if I need emergency care. The doctor's can charge whatever they want. The insurance won't pay it. And I get @#$%%. What are my options? Do I have any? Or is it like the insurance company said, too bad for me?

• Answer:

  See, this is a PERFECT example of what health care reform REALLY should be about - transparant, flat billing for services rendered. The hospitals, doctors, providers, etc, are going to screw you over by overbilling for services. You can ALWAYS call, and ask them to price it down. They don't have to do it.