Short Answer

Use your public insurance now and follow its rules: get referrals, prior authorization, and use in‑network providers. In North Carolina, Medicaid and medical providers can claim repayment from any settlement through liens, subject to caps and priority rules. Track every bill and explanation of benefits, appeal denials on time, and do not delay treatment while your claim is pending. Make sure your child’s involvement is documented—even if the crash report missed it—so their medical care and claim are protected.

Understanding the Problem

You’re asking, in North Carolina, how you can use public insurance for doctor‑ordered head scans and treatment while a personal injury claim is open, and still make sure everything is covered and handled correctly in your claim. You have persistent headaches after a head injury and were referred for specialized scans. You want to complete treatment before advancing the claim and you also need your child’s injuries documented since the crash report omitted them.

Apply the Law

North Carolina lets you use public insurance (such as Medicaid) for injury care while you pursue a claim against the at‑fault party. Public insurers and medical providers may be repaid from your settlement through liens: Medicaid’s lien has priority over provider liens and is capped by statute, and provider liens must follow notice and distribution limits. A lien is a legal claim against your settlement, not against you personally, and your lawyer must distribute funds by law. The main forums you’ll deal with are your insurance plan (for authorizations and appeals), the treating providers (for billing and lien notices), the at‑fault insurer (for claim payment), and, if needed, the county court for filing suit before the general three‑year deadline for personal injury lawsuits. Coverage and appeal deadlines are set by your plan and appear on your denial notice.

Key Requirements

• Follow plan rules: Get required referrals/prior authorizations and use in‑network providers to keep scans and treatment covered.
• Notify and coordinate: Tell your public insurer you have a third‑party claim; they may assert a lien and require updates.
• Document everything: Keep itemized bills, explanations of benefits, denial letters, and provider lien notices.
• Honor lien limits and priority: Medicaid is paid first up to statutory limits; valid provider liens share the remainder under North Carolina’s distribution rules.
• Protect deadlines: Appeal any coverage denial by the date on your notice and file suit before North Carolina’s general three‑year limit for personal injury claims if settlement is not reached.
• Fix report gaps: If a crash report omitted an injured child, request an amendment so their claim and treatment are recognized.

What the Statutes Say

• N.C. Gen. Stat. § 108A-57 (Medicaid lien on third-party recoveries) - Medicaid can recover from settlements, with caps and a process to resolve amounts.
• N.C. Gen. Stat. § 44-49 (Medical provider lien) - Providers may assert a lien if they furnish notice and itemized charges.
• N.C. Gen. Stat. § 44-50 (Distribution limits) - Total provider lien payments are limited, and funds are distributed pro rata after fees.
• N.C. Gen. Stat. § 20-166.1 (Crash reports) - Governs crash reporting and records, which you can seek to amend if details are missing.

Analysis

Apply the Rule to the Facts: For your head scans, use your public insurance now, secure prior authorization from your plan, and keep all bills and EOBs. Your insurer (for example, Medicaid) will likely assert a lien on any settlement; that lien comes ahead of provider liens and is limited by statute, so it will not swallow the entire recovery. Do not wait to finish every appointment if the statute of limitations is approaching; file suit on time to protect the claim while treatment continues. For your child, ask the law enforcement agency to add them to the crash report and keep their treatment bills organized so their claim and any lien resolution are handled properly.

Process & Timing

1. Who files: You or your attorney. Where: Your public insurance plan (for prior authorization and any appeal), treating providers (billing), the at‑fault insurer (claim), and the law enforcement agency that wrote the crash report (amendment request). What: Submit your plan’s prior authorization request and, if denied, the plan’s appeal/grievance form; provide providers with claim and insurance information; send a written request with proof to amend the crash report; report third‑party liability to your public insurer. When: Follow the appeal deadline on any coverage denial; track the general three‑year limit to file a personal injury lawsuit in North Carolina.
2. Next: Your plan issues an approval/denial; if approved, complete scans and treatment. If denied, appeal promptly and consider a narrow peer‑to‑peer review or additional documentation from your doctor. The at‑fault insurer continues its investigation; the agency reviews your crash report amendment request (timelines vary by agency).
3. Final: When the claim resolves, your attorney obtains final lien amounts from Medicaid (if applicable) and providers, applies statutory caps and priorities, and disburses settlement funds accordingly. You receive copies of the final EOBs, lien statements, and settlement distribution.

Exceptions & Pitfalls

• Waiting to “combine all bills” and missing the lawsuit deadline; file on time and keep treating.
• Getting scans without prior authorization or using out‑of‑network providers, which can trigger denials or higher costs.
• Failing to notify Medicaid/your public insurer about the third‑party claim, which can delay approvals and complicate lien resolution.
• Overlooking provider lien notices; unpaid valid liens must be addressed at settlement and are subject to statutory limits.
• Crash report errors that omit an injured child; without correction, the at‑fault insurer may question the child’s claim.

Talk to a Personal Injury Attorney

If you’re dealing with injury treatment under public insurance while pursuing a claim, our firm can help coordinate coverage, fix crash report issues, and protect your recovery. Reach out 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.