I love the "consumer" model of health care....guess what, you aren't. Medical stuff is the only thing you cannot price shop or even compare. Even if you could, the hospital will charge you differently for different insurers...and as I found out once....if you don't hit the deductable (five stitches from a minor accident) you don't even get your insurance company rates (all that money and I'm not even in the Buyer's Club ?)
When you get really sick, every single thing you use is billed. Bed. Docs...Drugs...machines (and when a relative had a breast biop done, they charged for each use of the machine, not just "turn on and use". No normal person can keep track of this, and the hospitals know it. Insurers, who have an idea, will fight tooth and nail on costs and fees.
What we end up with now is two tiers. If you can get into or afford private insurance, not an ACA plan, you are working for Government or a very large company. If you don't, you are stuck with an ACA plan, which will NOT cover a majority of your doctors, or even possibly the hospital. Yes, folks who work for Govt. or big companies are still somewhat protected from the health insurance nightmare.
So, yes, it is very conceivable that this person is getting nailed by "out of network" charges. When you are laying in a hospital bed, you don't ask the attending if they take Aetna or Blue Cross, and send them hither if they say no.
For years, US insurers have benefited by their claims practices, fobbing off the poor and old on the Government, and skimming the cream of "healthy" risk pools. The ACA stopped the worst practices, but also forced anyone who could to leave the exchange plans. I got an ACA plan once. Every single provider..my kids pediatrician....wife's ob/gyn....my GP...the allergiest "oh we're sorry we don't accept any insurance from the exchange". You are all the access of a Medicaid patient but you pay full price for the lack of services....and I used to pay 1/3 the price for the same docs to smile at me and take a $20 copay...so an ACA plan is a non-starter in the NYC area and I'd seriously consider paying the tax penalty if I was unable to get coverage elsewhere.
The insurance industry has managed to propagandize the low information bits of our population to not want "socialist" medicine. I've been exposed to the Canada and German systems...while not perfect, they are a hell of a lot more fair and reasonable than the mosh that we have here in the US...the only folks who are "OK" are the Big Company and Government policy people. All the rest are one illness away from a trip to Bankruptcy Court.
Thank the Bush Administration for not allowing negotiation of drug prices, and the Obama Administration for the ACA and tax penalty. The lack of a 'government option' was clearly designed to make sure there wasn't competition or any reliable measure of the private industry practices.
At a very minimum, there should be published price schedules at hospitals, a right to sue health insurers for poor claims practices or denial of vital services, and one single payer pool, not the cherry picking of the healthy. After all, if you limit coverage to folks who can work a 40 hour week, you've just cut off most of your expensive patients...and insurance companies have gotten away with this far too long.