Do I need to worry about this or do anything else?

In November of last year, I had an ultrasound at around 10 weeks pregnant. For each of my pregnancies, I go to my PCP first as they monitor my progesterone levels during pregnancy and communicate that with my OB. I don’t see my OB until at least 8 weeks pregnant. Anyway, my PCP confirmed the pregnancy, drew blood and ordered an ultrasound. They gave me a form that said that they had already checked and confirmed that it was covered by my insurance at the time (Bright Healthcare – they are no longer my insurance).

I scheduled and had the ultrasound. Later on, I got the EOB stating that they weren’t going to pay any of the $424 bill for the ultrasound. Here is the stated reason:

“CONFIRMS THAT BHPCO REVIEWED AND APPROVED SERVICES RENDERED BY A NON-PARTICIPATING PROVIDER ARE NOT COVERED. IF PROVIDER IS IN NETWORK UNDER A DIFFERENT TAX IDENTIFICATION/NPI NUMBER , THE CLAIM MUST BE RESUBMITTED WITH THAT TAX IDENTIFICATION/NPI NUMBER FOR CONSIDERATION.**** PLEASE REFER TO THE LIMITATIONS/EXCLUSIONS SECTION OF THE CERTIFICATE OF COVERAGE. THESE SERVICES APPEAR TO BE RENDERED BY A NON-EFFECTIVE PROVIDER OR GROUP. THE PROVIDER MUST REBILL UNDER AN IN-NETWORK NPI/TIN COMBINATION. TO OUR BRIGHT HEALTH MEMBER, THIS IS NOT YOUR RESPONSIBILITY. YOUR PROVIDER WILL REBILL USING THE CORRECT INFORMATION FOR YOUR CLAIM TO BE RECONSIDERED.”

Now, I know that the EOB says that it’s not my responsibility and that it’s an issue with how the provider submitted the claim. But the EOB has not been updated on the online member portal (I assume because the provider has not resolved the issue). They did include a page about the No Surprises Act for unexpected charges in with the EOB when it was mailed to me (not sure if this applies here – the ultrasound was done at a separate clinic that does imaging…what I think happened is that the clinic was in-network, but the ultrasound tech was not).

When I looked up timely filing rules, this is what is stated in the plan’s certificate of coverage documents:

“Claims for Covered Health Services from a Non-Network or Non-Participating Provider must be
submitted to Us within one year (365 days) from the date of service. If your Provider does not file
a claim for You, You are responsible for filing the claim within the one-year deadline. Claims
submitted after the deadline are not eligible for benefit payment or reimbursement. If a claim is
returned to You because We need additional information, You must resubmit it with the information
requested within 90 days of receipt of the request.”

I have never received a bill from the clinic for the ultrasound. Do I need to do anything? I always just operated with the idea that until there’s a bill, it’s not my issue as long as the claim was filed. Can I still assume that point of view?