Most importantly, most states have laws mandating insurers use in network rates for certain instances of using out of network providers, including in factual instances like you described (i.e. in network hostitals and out of network providers). Seperately, most states have statutes awarding attorneys fees to the insured when claims have been denied in bad faith, like refusing to adjust bills to in network rates when mandated by law.
Most importantly, most states have laws mandating insurers use in network rates for certain instances of using out of network providers, including in factual instances like you described (i.e. in network hostitals and out of network providers). Seperately, most states have statutes awarding attorneys fees to the insured when claims have been denied in bad faith, like refusing to adjust bills to in network rates when mandated by law.