Most plans are not paying the inflated rates. Federal law requires plans to cover emergency care by out-of-network providers, but the plan can limit the payment

Most plans are not paying the inflated rates. Federal law requires plans to cover emergency care by out-of-network providers, but the plan can limit the payment to the usual and customary rate for the services. This leaves the patient susceptible to balance billing for the inflated rates. Self-insured employer group plans, which is what most people have, are federally regulated. State law does not apply to them. State-regulated plans often are required to cover the full costs depending on state law, so the author's point is valid there.