My provider is out of network with an insurance plan. He covers the wound clinic at the hospital as part of a hospital agreement. He can not refuse to see a patient who comes through the wound clinic as he is the only surgeon who covers. If the patient has no oon benefits in their policy and my claim is denied stating provider is oon and patient has no oon benefits, can I appeal on any grounds? I'm not sure if the Emergency care policy applies to this scenario if it's not an Emergency room. Any thoughts on this? Thank you.