Morning,

Probably a fairly common question but one I have not experienced. A few weeks ago my doctor sent me to an imaging center for a calcium scoring, due to pain in my chest, family history, and risk factors (weight, blood pressure). This was an in-network facility, as is my doctor. I am on the NJ Educators Plan with Horizon BCBS. I just received the EOB and the $2000 plus payment was denied due to code M329 which states that an authorization is required for this service and there is none on file. It states that 0.00 was paid, but also that I owe 0.00. Now I assume this is because it is in-network and their contract will not allow them to bill, but I am not really sure. Is this an issue between my provider, the imaging center, and my insurance, or will I potentially be receiving a bill in the mail for this procedure? The EOB does make it seem pretty clear that I should not be billed but am unsure of what the laws and contract allow. Looking in my online portal shows an authorization was granted 3 weeks after I got the procedure, so I'm hoping that would be in my favor and its just a matter of retro authorizing or changing date? ALSO, under my benefits details it says MRIs, CAT scans, Diagnostic and screening laboratories all do not need prior auth if in-network. Very confused by all this. Unfortunately my health plan is not open until tomorrow to call so wanted to get some prior info. Any insight is appreciated. Thanks!