hospital visits are different from clinic visits

If someone is admitted to the hospital and is seen by the on-call providers/specialists, the insurance has to pay since it is considered as an emergency. You may need to pay a copay for in-network providers, but the insurance should pay 100% for all out-of-network providers in the hospital.

This is different from clinic visits. The insurance can deny the claim if you see an out-of-network doctor in non-emergent situation.

If you have to pay, you only need to pay the amount shown in the EOB (Explanation of Benefits) sent from your insurance company.