Matt- There is a doctor owned hospital in my town that is out of network, but they only charge you what you would pay for in network. I'm guessing they do this so it's their choice and they have more leeway? Not sure, but I have had several procedures done there and they only charge the in network rate (though what you pay doesn't count toward your in network deductible as far as your insurer is concerned- they apply it toward your out of network deductible.)