Surprise balance bills from in-network hospital's out-of-network anesthesiologist

When a patient schedules surgery at an in-network hospital, the anesthesiologist, pathologist, or radiologist assigned to their case is frequently out-of-network, resulting in a surprise bill averaging $1,219 that the patient only discovers weeks after the procedure. Patients cannot choose or even know who these providers will be beforehand, so there is no way to shop around or verify network status. The No Surprises Act (2022) addressed emergency situations but left gaps for scheduled procedures in certain states, and enforcement is fragmented across state insurance commissioners with tiny audit staffs. This persists because hospitals contract with independent physician staffing groups that deliberately stay out of major networks to maximize reimbursement rates, and insurers have no leverage to force them in-network since the hospital controls facility access.