When she went back to the states she had another issue and went to the doctor under Obamacare. She said the first thing that the doctor's office did was make sure her insurance was all in order and that all the forms were signed before they would consider looking at her.
This is pretty standard and it has nothing to do with ObamaCare. They likely would have still seen her even if she didn't have insurance or if the insurance wasn't active. Providers spend a great deal of time and effort (and money) trying to get their money from insurance companies.
Try getting any attention in an emergency room without first filling out insurance forms or having cash or credit on hand. Providers are extremely greedy.. they have full time staff which account for 30% of healthcare costs that do nothing but make up (fake) bills and shake everyone down for money. I used to work on many doctor's office computers. One doctor made headlines when he got caught billing for procedures that were never done, and in other cases having his nursing assistant do procedures (illegally) instead of the doctor. The nursing assistant eventually set the doctor up to escape being prosecuted himself. He planted cameras around the office which showed that the doctor would go from patient to patient without changing gloves.
If the insurance company rejected a claim.. the provider would just submit the same claim again.. and again.. and again. until it was paid. There is no rule against doing that.