ER Care: Does a Hospital Have to Accept Your Insurance?

Say one day you get hit by a car and have to go to the ER. You finish up with all the stuff the doctor had to do to fix you, and you get to the payment part. You hand the hospital your insurance card, say Blue Cross Blue Shield. Then they say, "Sorry, we dont accept BCBS" and they hand you a bill for $100k. Is this a realistic scenario?

I know under the ACA, insurance companies must treat all ER care as "in network" and therefore pay for it. However, do all hospitals have to accept your insurance company's payment as payment in full, or can they refuse to accept your insurance all together (o
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