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It's more rich when your client plays by all the rules - stays in network for a procedure and get whacked with balance billing from a OON ass't surgeon or anesthesiologist.
Of course, there's no way any client can exercise due diligence in these cases.
In my experience these situations are quite common. There are always going to be PARE doctors to deal with:
P=Pathologists
A=Anesthesiologists
R=Radiologists
E=Emergency Room Doctors
aka RAPE doctors, they are seldom, if ever, in-network contracted with the carriers.
However, 99.9% of the time the carrier will review these and pay the claim at in-network % of actual bill, at least for my clients.