ER visits for emergencies are also covered as in-network care under the ACA, even if you're half way across the country. I know cuz I was 1500 miles into a road trip when I went to the ER. My insurance covered it as in-network.
https://arstechnica.com/science/2021/06/biggest-health-insur...
> Doctors and hospitals are condemning plans by UnitedHealthcare—the country’s largest health insurance company—to retroactively deny emergency medical care coverage to members if UHC decides the reason for the emergency medical care wasn’t actually an emergency.
Multiple attempts on my part to resolve this yielded nothing. I contacted the state of TX, who brought suit against both parties (insurance & service provider). Somehow, the day before the court appearance they all agreed to settle the claim at no cost to me.
Thankfully the bill I did receive was somewhat reasonable, and I was able to pay it without much issue.
So the insurance is saying "If you paid $80,000 for a medevac, we would have covered your hospital bill".