Is A Colonoscopy Covered Under The No Surprises Act?

I had a colonoscopy last October. I chose an in-network provider. That provider chose an in-network pathology provider to perform the pathology.

However, the individual doctor who provided my pathology results was apparently out-of-network. Because of that, I am being billed $575 (balance billing) which is the difference between what the insurance company paid and what the provider is charging. If this claim had been treated as in-network, I would — of course — not owe anything.

I have been arguing with my insurance company. My point is that the pathology sample was sent to an in-network pathology provider, BUT the individual pathologist was out-of-network. That certainly is something that neither I nor the colonoscopy provider had any control over.

I am not sure if that argument will prevail, but I also think the No Surprises Act may come into play here. However, I am seeing conflicting information online that may indicate that the No Surprises Act only applies to procedures performed in hospitals.

My colonoscopy was performed as an outpatient procedure at a medical clinic adjacent to a major hospital. I was sedated like an actual hospital surgery and — quite honestly — everything looked and felt as if I was having a procedure at an actual hospital.

Does this procedure fall under the No Surprises Act? If not, how can I argue with my insurance company to make them tell the provider that they should not be allowed to balance bill me?

I am in Oregon in case that matters. I know some states have different No Surprises Laws that may provide more benefits to consumers than the Federal Law.