Short Answer

In North Carolina, past medical expenses are measured by what was actually paid (or is still owed) to satisfy the bills, not the original sticker price. To verify the insurer’s number, match each charge to the provider’s itemized bill and your health plan’s Explanation of Benefits (EOB), confirm any lien or reimbursement claims, and apply North Carolina’s medical lien rules and caps before finalizing a settlement.

Understanding the Problem

In North Carolina, you want to confirm the insurer’s medical-expense math before resolving a motor vehicle accident claim. You went to the ER and received hospital, ambulance, and ER doctor services, your health plan asserted a lien, and your attorney and the insurer are trading numbers focused on medical specials. The question is whether the insurer used the correct paid amounts and lien figures, given that you had only emergency treatment and no ongoing diagnosed injury.

Apply the Law

North Carolina limits proof of past medical expenses to the amounts actually paid to satisfy the bills that were satisfied, and the amounts necessary to satisfy any unpaid bills. Providers that treated you can assert a statutory lien against your personal-injury recovery for their reasonable charges, but those liens are subordinate to attorney’s fees and are capped in the aggregate. Certain health plans and government programs have separate reimbursement rights that can override or sit outside those provider-lien caps.

Key Requirements

• Use paid/owed amounts: Verify the insurer used amounts actually paid by you or your plan, or the amount still necessary to satisfy an unpaid bill, not the full sticker price.
• Tie every charge to proof: Reconcile each provider’s itemized bill with EOBs and payment records showing insurer/plan payments, contractual write-offs, and your responsibility.
• Account for liens: Identify all provider liens and health-plan reimbursement claims; confirm perfection, reasonableness, and the correct payoff amounts.
• Apply the lien cap and priority: After attorney’s fees, total provider liens cannot exceed a statutory percentage cap of the recovery; if insufficient funds remain, liens are typically prorated.
• Watch special plan rules: Medicare, Medicaid, and the State Health Plan have statutory reimbursement rights that can differ from provider lien caps and must be resolved before disbursement.

What the Statutes Say

• North Carolina Rule of Evidence 414 (Medical expenses evidence) - Limits proof to amounts actually paid or still owed to satisfy medical bills.
• N.C. Gen. Stat. § 44-49 (Medical provider lien) - Allows providers to claim a lien for reasonable charges on personal-injury recoveries.
• N.C. Gen. Stat. § 44-50 (Priority and cap) - Attorney’s fees come first; total provider liens are capped and often prorated if funds are short.
• N.C. Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Establishes reimbursement rights that can affect settlement distributions.

Analysis

Apply the Rule to the Facts: Because you had ER-only treatment, start with the hospital, ambulance, and ER physician bills. Under the paid/owed rule, the insurer should use the amounts your health plan actually paid plus any co-pays or balances you still owe. Next, validate your health plan’s lien against the settlement and ensure provider liens are within the statutory cap after attorney’s fees; if funds are tight, expect prorating among providers. Finally, confirm that separate health-plan rights (for example, a state plan) are handled under their statutes before disbursement.

Process & Timing

1. Who files: Your attorney. Where: Negotiation with the liability insurer; no court filing is required to verify calculations. What: Request itemized bills from each provider and all EOBs from your health plan; ask the insurer for its medical specials ledger with sources for each line item. When: Do this before you sign a release or finalize settlement terms.
2. Reconcile line by line: match each CPT/HCPCS-coded charge to the EOB’s allowed amount, write-off, plan payment, and your responsibility; confirm that any MedPay or other payments are credited properly. Simultaneously, request written lien/repayment figures from each provider and the health plan.
3. Apply lien rules and finalize: deduct attorney’s fees, apply the provider-lien cap and prorate if needed, honor any separate health-plan or government program reimbursement rights, then obtain lien releases and issue a settlement statement before funds are disbursed.

Exceptions & Pitfalls

• Using gross charges instead of paid/owed amounts under Rule 414 inflates specials; insist on EOB-backed figures.
• Missing separate bills: ambulance, ER facility, and ER physician often bill separately; make sure all are reconciled.
• Double counting or ignoring write-offs: exclude contractual write-offs and prevent counting payments twice.
• Health-plan rights differ: Medicare, Medicaid, and the State Health Plan have distinct rules; do not assume the provider-lien cap applies to them.
• Disbursing before lien resolution: paying clients before clearing liens can create personal liability and delay releases.

Talk to a Personal Injury Attorney

If you're dealing with disputed medical bills, liens, and confusing EOBs after a crash, our firm has experienced attorneys who can help you understand your options and timelines. Call us today at 919-341-7055.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.