Short Answer

In North Carolina, a Medicare Advantage plan may seek reimbursement from your injury settlement for injury-related benefits it actually paid. It cannot collect twice for the same charge. If the plan confirms the ER bill was fully reimbursed by another insurer and shows a zero balance, there is no remaining lien for that ER visit. Still, confirm in writing and check for any other related dates of service.

Understanding the Problem

You want to know if a North Carolina Medicare Advantage plan can claim money from your injury recovery for emergency room treatment when another insurer already paid that ER bill. Here, the insurer told your attorney the ER visit was paid and fully reimbursed by the auto insurer, leaving a zero balance and no open lien.

Apply the Law

Under North Carolina practice, Medicare Advantage plans assert reimbursement rights for injury-related medical payments, but they do not have a North Carolina medical provider lien. Their claim is limited to amounts they paid that remain unpaid by a primary payer. If a primary payer (like an auto insurer) already reimbursed the plan for a particular charge, the plan cannot recover that amount again from your settlement. The issue is usually handled directly with the plan or its recovery unit; repayment timing generally runs from the date you obtain a third-party recovery, and plans commonly require payment within a short window after settlement.

Key Requirements

• Plan payment: The plan must have actually paid injury-related charges.
• Related to the accident: Only bills reasonably connected to the accident are reimbursable.
• Third-party recovery: The beneficiary obtains a settlement, judgment, or award.
• No double recovery: If a primary payer already reimbursed the plan for that line-item, no additional reimbursement is owed for it.
• Notice and documentation: The plan should itemize payments and confirm any zero balances in writing before settlement funds are disbursed.

What the Statutes Say

• N.C. Gen. Stat. § 44-49 (Medical provider lien) - Gives providers a lien on injury recoveries; does not create a lien for health plans.
• N.C. Gen. Stat. § 44-50 (Enforcement; attorney’s fees priority) - Caps/enforces provider liens; not applicable to Medicare Advantage plans.
• 42 C.F.R. § 422.108 (Medicare Advantage secondary payer rights) - Recognizes MA plans’ recovery rights when other insurance should pay first.
• 42 U.S.C. § 1395y(b)(2) (Medicare Secondary Payer) - Establishes that Medicare is secondary to other coverage for injury-related care.

Analysis

Apply the Rule to the Facts: The plan reports the ER claim was paid and then fully reimbursed by the auto insurer, leaving a zero balance. Because the plan has already been made whole for that charge, there is no remaining amount to recover from your settlement for that ER visit. Confirm that the zero balance applies only to that date of service and verify whether any other accident-related claims were paid and remain outstanding.

Process & Timing

1. Who files: The injured person or their attorney. Where: Communicate directly with the Medicare Advantage plan’s recovery unit. What: Request an itemized list of accident-related payments and a written confirmation of any zero balances or a final demand. When: Do this before settlement and pay any final demand within the plan’s stated timeframe (often within 30 days of settlement).
2. Reconcile the itemization: dispute unrelated charges, confirm any reimbursements received from primary payers, and secure a revised, final figure or zero-balance letter. Timing varies by plan; allow several weeks.
3. Close out: once you receive a written final demand or zero-balance confirmation for the relevant dates of service, retain it in the file and disburse settlement funds accordingly.

Exceptions & Pitfalls

• Other dates of service: A zero balance for one ER visit does not resolve later follow-up care the plan paid.
• Misallocation: Ensure the “reimbursement by the auto insurer” actually went to the plan for that specific claim, not just to the provider.
• Coding disputes: Challenge unrelated or pre-existing condition charges that the plan flags as accident-related.
• Reopened claims: If the primary payer reverses payment later, the plan may reassert a claim; keep documentation.
• Mixing statutes: North Carolina medical provider lien statutes do not govern Medicare Advantage plan reimbursement; do not assume lien caps apply to a plan’s claim.

Talk to a Personal Injury Attorney

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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.