Hospital in network, provider out

Feeling frustrated here. I was referred to a hospital system that is in network for a surgery. At the consult, I was referred to a different surgeon. I specifically asked the administrator if the other surgeon is in network or if I needed to verify insurance and she said no, it is unnecessary, all providers here take your insurance. Looking back, I should have called anyway because this was apparently bad advice. This is the first time I have ever used my health insurance for anything besides a yearly physical so I did not know there is a difference between “accepts your insurance” and “in network”.

Bills are here. My insurance paid the full $20,000 facility fee and some of the anesthesia (i had to pay $700, they paid $900).

The surgeon fee, around $4000, is pending. The after surgery consult was partially paid by my insurance and notes the provider is out of network. I had to pay $100 for OON consult and the insurance company also paid $100. But the surgeon fee is still pending. Any idea why this is?

I have PPO insurance. My out of network deductible is $1000, which I am nearly at due to anesthesia. The insurance company covers 80% after deductible. Does this mean I will owe the surgeon $800 + remainder from out of pocket deductible? I’m not understand where out of pocket comes in or what that means exactly. Trying to figure out how much I will potentially owe. Very expensive mistake, but now I know better and will never take them at their word again.