Man learns the difference between Harvard Vanguard and Harvard Pilgrim the hard way

We paid a $100 at the general ER and then another $100 copay at Mass Eye and Ear ER for my son when he smashed his face taking a tumble in the woods while running down a hill. They tried to say it was not an emergency even though another emergency room sent us there. I complained loudly and they paid it.

I think Harvard Pilgrim has a beef with Mass Eye and Ear and is taking it out on the patients. Denying that ER care at MEEI was an emergency and refusing to pay seems to be their standard operating procedure. Either that, or they have some total a$$hole in some small department who needs to be everted through their pharynx.

That your president and your former governor's policy on health care is to force you to do business with these people.

called Harvard Community Health Plan. I don't understand why they were split up; maybe they should be merged back together to avoid problems such as this?

While what this gentleman went through is common and unfortunate, it's a byproduct of not understanding one's own health insurance plan. They're complicated, and most people don't get it.
First, his primary care, or the doctor covering his primary care late at night doesn't A) know what kind of insurance the patient has nor B) cares what type of insurance he has. The MD suggested the pt go to Mass Eye and Ear for an eye issue. It is a patient's responsibility to know (not making a judgement here; it's simply the language used in plan benefit docs and whatnot) what facilities are in or not in their network. Mass Eye and Ear was not in this patients network and he went there anyway. While the Member Services phone line was closed at that time of evening, the website certainly works for checking available in-network facilities. MGH, Brigham, etc are all in any HPHC network. The gentleman could have gone to any of these.
Second, HPHC actually paid for a portion of the OON ER visit at what is called 'reasonable and customary charges'. These approximate the reimbursement that a similar contracting facility would get for the services rendered. The remaining balance is being 'balance billed' to the patient (a contracting, in network facility by contract would not be allowed to balance bill) as they are allowed to do. Some insurances will cover a balance billed charge for an OON ER visit, others don't. Right or wrong, it's allowed.
Third, the decision surgery was required was made at 2am, but was performed at 10am. While it was certainly necessary, insurance looks at 'emergency' care as a life or death thing. If the surgery was a true emergency, it would have been done at 2am and not 6 hours later. Again, not making a right or wrong judgement here- that's just how HPHC looks at it.

This stuff happens frequently to people- they simply go where they like without checking the available options and end up getting screwed. (I am willing to bet that this gentleman also signed a waiver of financial responsibility before his procedure, but left that out) This guy simply did what his doctors told him to do (most of us would) without realizing that the doctors don't know every patient's insurance and available networks and stuff off the top of their heads. Sucks, and I hope his appeal works, but it pays to understand how your plan works.