[dmeeker]

My read of the fourth bullet is that if you're receiving non-emergency service from an out-of-network provider, they can still balance bill you as long as you've signed the plain-language consent. (Presumably with such signature being a pre-requisite to receiving services.)

[jsmith45]

Agreed. They are making in network and out of network the same from the the cost sharing perspective. To avoid screwing over out of network providers, they allow out of network balance billing, but only with consent.

The actual rule also goes into things like consent to be balance billed for your knee surgery, is not consent to be balance billed for the ICU care when that surgery goes wrong and you nearly bleed out, and suffer major organ damage, etc...

This consent option is not always available, an in those circumstances, balance billing is simply prohibited, and in network and out of network are fully equivlent in those cases from a patients' perspective.