Jeffrey Craig Hopper is a probate attorney and Little League coach in Austin, Texas, so he knows all about following the rules. Still, accidents happen. Last June on the Little League field, an errant baseball smashed into his face.

His wife, Jennifer, remembers rushing to the field.

“His eye was swollen shut enough that we weren’t sure if he could see,” she says.

Even in that moment of panic, Jennifer Hopper realized that there are rules when it comes to using health insurance that can hugely influence the size of the medical bill. Care providers who are “in network,” she knew, cost much less, so she made absolutely sure to drive Jeffrey to the emergency room of a hospital in Austin that is part of their insurance network.

That sounds straightforward, but, as the couple soon learned, it doesn’t always work out that way — some patients still get slapped with big bills, even when they try to play by the rules.

In the end, Jeffrey was OK — the ball broke some facial bones around his eye, but they healed and his vision was fine. Jennifer, however, was surprised by what happened next. After she’d already settled with the hospital, paying the copayments for the ER, the ER doctor sent the couple a separate bill for more than $700.

“It felt kind of random,” she says. “How do I know who’s going to charge me, and who’s not going to?”

Like many patients, Hopper assumed that if she went to a hospital that the insurance company had designated as being within her network, the doctors who work there would also, of course, be in the network.

But that’s not necessarily true. Emergency room doctors, radiologists and anesthesiologists often don’t work for the hospital. They work for themselves, often in large practice groups, and it’s up to them to sign their own deals with insurance companies.

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Jeffrey R. Ungvary President