Is This An Example Of "Surprise Billing" Under The No Surprises Act And If So Who Is Responsible To Fix The Situation?

My insurance coverage is through an employer-provided health plan. The employer is a governemnt entity (school district). The plan is self-insured — in case that matters.

I had a colonoscopy in October. I went with an in-network provider and the bills/EOBs for the doctor, facility and anesthesiologist all came back as in-network.

However, the bill/EOB for the pathology laboratory came back as out-of-network. I had already reached my in-network out-of-pocket max, so if this was in-network I would owe nothing for the pathology lab work.

The bill is for $1,000+, but my insurance is only covering 60% of the “covered amount.” It appears that I am responsible for all of the amount above the “covered amount” because the provider is out-of-network plus the other 40% of the covered amount. This means I may be on the hook for around $800. Again, if this had been processed as “in-network” I would have owed nothing.

2 Questions:

1) Does something like this qualify as a “Surprise bill” under the No Surprises Act?

2) If so, who has to make changes? I’m assuming the insurance company needs to re-process the claim as “in-network” and then deal with the provider on their own.

Any advice/knowledge that can be provided would be appreciated.