Short Answer

In North Carolina, once your auto medical payments (med pay) coverage is exhausted, your best next step is to use your health insurance for ongoing treatment and ask the provider to bill it. The at-fault driver’s insurer typically does not pay treatment bills as you go; those get addressed when the claim settles. If a balance remains, your provider can assert a lien against any settlement, subject to North Carolina caps and reimbursement rules.

Understanding the Problem

You were hurt in a North Carolina car crash, your med pay is used up, and your physical therapist expects payment for continued care. The decision point is simple: can you use health insurance now, or should you wait for the at-fault insurer to pay? This article explains who pays during treatment, how remaining balances are handled under North Carolina law, and what to do next so care can continue without unnecessary delays.

Apply the Law

Under North Carolina law, med pay is first-party auto coverage that pays medical bills up to your purchased limit. After it is exhausted, ongoing bills are typically handled by your health insurance (with your usual copays/deductible). The at-fault driver’s liability insurer generally pays only once—at settlement or judgment—not as you treat. North Carolina gives medical providers a lien on any personal injury recovery, and it caps how much of your settlement can be taken by provider liens. Government programs and some self-funded health plans may also claim reimbursement from your recovery.

Key Requirements

• Use health insurance after med pay ends: Ask your provider to bill your health plan for ongoing physical therapy to apply contractual discounts and cost-sharing rules.
• Expect no “pay-as-you-go” from liability insurers: The at-fault insurer usually reimburses medical costs only at settlement, not during treatment.
• Provider lien rights exist: North Carolina allows providers to claim a lien on your injury recovery for reasonable charges tied to the accident.
• Settlement protection cap: The total paid to all provider lienholders is capped at a portion of your recovery after attorney’s fees, protecting your net.
• Reimbursement claims vary by payer: Medicare, Medicaid, TRICARE, the State Health Plan, and some self-funded ERISA plans may seek repayment from your settlement under special federal or plan rules.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien) - Grants providers a lien on personal injury recoveries for accident-related, reasonable charges.
• North Carolina Gen. Stat. § 44-50 (Distribution and cap) - Limits total provider lien payments to a share of the recovery after attorney’s fees, protecting the injured person’s net.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien/recovery) - Authorizes Medicaid recovery from personal injury settlements with allocation limits.

Analysis

Apply the Rule to the Facts: Because your med pay is exhausted, ask your physical therapy provider to bill your health insurance for ongoing sessions so you benefit from network discounts and normal cost-sharing. Do not wait for the at-fault insurer; they typically pay only after settlement. If a balance remains, your provider may agree to continue treatment under a lien or letter of protection, and any lien must be handled from settlement funds subject to North Carolina’s cap on provider liens.

Process & Timing

1. Who files: You (or your attorney). Where: Your provider’s billing office and your health insurer. What: Provide your health insurance card and request in-network billing; if needed, send a letter of protection asking the provider to hold any balance for payment from settlement. When: Do this immediately and within your health plan’s claim-filing window (often 90–180 days from the date of service).
2. Notify the at-fault insurer that you are treating and will present the full claim after your course of care. Continue treatment; claim updates and records gathering typically occur throughout, with EOBs arriving 2–4 weeks after each bill cycles.
3. When treatment stabilizes, present your claim to the liability insurer. Upon settlement, funds are disbursed from an attorney trust account: attorney’s fees/costs, valid liens/reimbursement claims (subject to statutory caps and plan/federal rules), then your net recovery.

Exceptions & Pitfalls

• Government and self-funded plans: Medicare, Medicaid, TRICARE, the State Health Plan, and some self-funded ERISA plans may demand reimbursement from your settlement under federal or plan terms that can override state limits.
• Provider won’t bill health insurance: Some providers choose not to bill insurance after crashes. Ask about a letter of protection or a payment plan, or consider transferring to an in-network provider that will bill your plan.
• Balance billing risks: In-network billing usually limits what you owe to copays, coinsurance, and deductibles; out-of-network billing can leave higher balances.
• Premature releases: Do not settle or sign releases before you know all lien and reimbursement amounts; this can delay disbursement and complicate negotiations.
• Missed billing deadlines: Late submissions to your health insurer can lead to denials, leaving you with larger balances while you wait for settlement.

Talk to a Personal Injury Attorney

If you’re worried about paying for therapy after med pay is exhausted, our firm can help coordinate billing, protect your settlement with lien caps, and navigate reimbursement rules. If you're dealing with these issues, our firm has experienced attorneys who can help you understand your options and timelines. 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.