Short Answer

Start by getting the itemized bill and the insurer’s explanation of benefits (EOB) for that exact date of service. Under North Carolina law, providers who claim a lien on your injury recovery must furnish itemized charges and records on request, and total medical reimbursements from a settlement can be capped and shared among providers. Contractual write-offs, coding denials, and government program liens (Medicare/Medicaid/State Health Plan) can also reduce payment. Ask for a written payoff and reconcile it line-by-line.

Understanding the Problem

In North Carolina personal injury cases, you want to know why one physical therapy date shows only a partial payment when other therapy dates were reimbursed. You (as the attorney) already contacted the billing service and received departmental contacts for payoff inquiries. The decision point is whether the shortfall is due to billing/plan adjustments or a legal cap on how much providers can collect from the settlement.

Apply the Law

North Carolina law gives medical providers a lien on personal injury recoveries but limits how much they can receive from the settlement and requires cooperation on billing details. The main forum to resolve these issues is between the provider’s billing department and the liability or health insurer; if a dispute persists, it can be addressed in civil court. Key timing often comes from the EOB appeal window and the settlement disbursement schedule.

Key Requirements

• Itemized billing and records on request: A provider claiming payment from your settlement must provide an itemized statement and pertinent records upon written authorization.
• Provider lien attaches to recovery: A health care provider’s lien attaches to settlement or judgment funds from the injury claim, but it doesn’t exceed statutory limits.
• 50% cap after attorney’s fees: Total payments to all providers from the settlement are limited to a percentage cap after deducting attorney’s fees; if multiple providers submit liens beyond the cap, they are paid pro rata.
• No preference among providers: When the cap requires sharing, you cannot favor one provider over others; payments are allocated proportionally.
• Government program recoveries: Medicare, Medicaid, and the State Health Plan follow their own recovery rules; these can operate differently from the provider-lien cap, and procedures can change.
• Plan/contract adjustments: Network discounts, coding edits, duplicate charge corrections, and deductible/copay rules can lawfully reduce individual date-of-service payments.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien) - Providers must furnish itemized bills/records and may assert a lien on injury recoveries.
• North Carolina Gen. Stat. § 44-50 (Distribution limits) - Payments to providers from a settlement are limited and shared if claims exceed the cap after attorney’s fees.
• North Carolina Gen. Stat. § 108A-57 (Medicaid recovery) - Sets Medicaid recovery rights from third-party liability funds.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - Establishes the State Health Plan’s right to reimbursement.

Analysis

Apply the Rule to the Facts: Because one physical therapy date shows only a partial payment, first obtain the itemized bill and EOB for that date to see whether a network write-off, coding denial, duplicate charge, or deductible/copay caused the reduction. If the provider seeks payment from the settlement, confirm they furnished itemized charges and calculate the post–attorney’s fee cap to see if pro rata sharing applies across all providers. If Medicare, Medicaid, or the State Health Plan paid, their recovery rules may explain why other dates were reimbursed differently.

Process & Timing

1. Who files: Plaintiff’s attorney. Where: Provider’s billing office and the liability/health insurer for the EOB appeal; civil court in the county of venue if a dispute persists. What: Request the itemized statement for the specific date of service, the insurer’s EOB, and a written payoff/lien ledger; send a written appeal or reconsideration to the insurer if the EOB is incorrect. When: Follow the EOB appeal deadline (often short; check the EOB).
2. Reconcile all provider liens against the settlement: calculate the available amount after attorney’s fees and allocate pro rata if total claims exceed the statutory cap; request updated payoff letters and releases.
3. Resolve government program recoveries (Medicare/Medicaid/State Health Plan) by obtaining final demand/confirmation of lien satisfaction before disbursing; if disputes remain, negotiate or seek court guidance.

Exceptions & Pitfalls

• If the provider won’t furnish an itemized bill or records after proper authorization, their lien may not be enforceable; use this to resolve improper balances.
• Do not overpay one provider when total provider claims exceed the post–attorney’s fee cap; allocate pro rata to avoid later disputes.
• Government program liens follow separate rules and can delay payment until final demands are issued; don’t disburse prematurely.
• Check for duplicate charges, miscoded CPT/ICD-10 entries, or application of payments to older balances that distort the date in question.

Talk to a Personal Injury Attorney

If you’re dealing with unexplained shortfalls on a therapy bill in an injury claim, our firm has experienced attorneys who can help you understand your options and timelines. Call us today to discuss your case.

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.