That's my point though, right? You're making it. It's impossible for me to do with the way these things are set up. If most of the hospital groups and the hospital coverage is "in network" but ED (and ED is just an example, you could substitute other things like Radiology, or Anesthesia, or the local GI group for example) isn't, that's not fair to the patient at all. Stuff like that is what drives people into bankruptcy even though they did the right thing by picking a plan that they believed would cover them. So what's the alternative for the patient? Just expect to go bankrupt when they go to the hospital? Because even if they're paying for insurance and think the hospital they are going to for their problem is "in network", there's no way for anyone to make sure all the services they would be getting are going to be covered under their in network plan. My point when I said you have to decide before stepping foot in the hospital is just that - the hospital system (and physicians have a large voice in that, whether they choose to exercise it or not) has (or rather, should) has some responsibility in terms of making sure that they only contract with groups where the insurance plans match up reasonably well. Because no one is going to blame the 'suits' - they're going to blame the people they think are fleecing them.
Since you asked, I'm a PGY-3 (but not a EM resident).