Short Answer

In North Carolina, confirm a zero balance by reconciling every provider’s itemized bills with your insurance explanations of benefits (EOBs) and by resolving any statutory liens or reimbursement claims before settlement funds are disbursed. Ask each provider and insurer for written “final balance” or lien-release letters. North Carolina law allows medical providers to claim a lien against your recovery, and public/health plans may require repayment, so get written clearance from all payers and providers.

Understanding the Problem

You want to know how, under North Carolina personal injury law, you can make sure no unpaid medical charges remain after treatment. As the injured patient, your goal is to verify and clear provider balances and any liens before settlement funds are released. A small copay showed up on one visit you thought insurance would cover, so you need a concrete way to confirm what, if anything, you still owe.

Apply the Law

North Carolina gives medical providers a lien on personal injury recoveries for reasonable charges related to the injury. Providers must furnish itemized statements on request, and the total paid to providers from your recovery is capped at a percentage of your net after attorney’s fees. Separately, some payers—like Medicare, Medicaid, the State Health Plan, and certain health plans—can demand reimbursement from your settlement. Resolution usually occurs through your attorney’s trust account before funds are released to you.

Key Requirements

• Get itemized provider statements: Ask each hospital, doctor, therapy group, and pharmacy for an itemized, injury-related ledger and a written “final balance” amount.
• Match bills to insurer EOBs: Compare every bill to your health insurer’s EOBs to confirm payments, denials, deductibles, and copays are correctly applied.
• Identify and resolve liens: Confirm any medical provider liens and pay them from settlement proceeds subject to the statutory cap; obtain lien releases in writing.
• Handle reimbursement claims: Check for Medicare, Medicaid, State Health Plan, and private plan reimbursement rights; secure written final demands and pay them before disbursement.
• Honor the cap on providers: Medical provider payments from your recovery cannot exceed the statutory percentage of your net after attorney’s fees; collect written zero-balance letters after payment.
• Disburse only after clearance: Funds should remain in the attorney trust account until you have all lien releases and zero-balance confirmations.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien) - Providers may claim a lien on personal injury recoveries for reasonable charges and must furnish itemized statements on request.
• North Carolina Gen. Stat. § 44-50 (Enforcement and limits) - Sets enforcement and limits, including the percentage cap against the injured person’s net recovery after attorney’s fees.
• North Carolina Gen. Stat. § 108A-57 (Medicaid lien) - North Carolina Medicaid may assert a statutory lien against third-party settlements.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan subrogation) - The State Health Plan has statutory rights to recover amounts it paid from liable third parties.

Analysis

Apply the Rule to the Facts: Because a small copay appeared on one visit, start by pulling the EOB for that date of service and asking the provider to confirm whether insurance was correctly billed and applied; if not, request rebilling. Since you’re unsure who paid what, request itemized statements from each provider and reconcile them with your insurer’s EOBs. Before any settlement disbursement, identify and resolve provider liens subject to the statutory cap, and address any Medicare, Medicaid, State Health Plan, or private plan reimbursement claims. Finally, obtain written zero-balance or lien-release letters from each payer and provider so you can confirm nothing remains unpaid.

Process & Timing

1. Who files: You or your attorney. Where: Each provider’s billing office; your health insurer’s member portal; Medicare’s Benefits Coordination & Recovery Center; North Carolina Medicaid’s third-party recovery unit (if applicable). What: Request “itemized account statement,” “final balance,” EOBs, and any “lien amount/final demand” letters. When: Do this as soon as treatment concludes and before settlement disbursement.
2. Reconcile and resolve: Match bills to EOBs; correct errors; calculate the provider-lien cap against your net after attorney’s fees; pay valid provider liens and reimbursement claims from the attorney trust account. Timing varies by payer; expect several weeks for final demands from public programs.
3. Close out and confirm: Collect written lien releases and zero-balance letters from each provider and payer. Your attorney issues the final settlement disbursement with the documentation saved to your file.

Exceptions & Pitfalls

• Do not assume the at-fault carrier paid your providers; they typically pay you, leaving balances unless resolved at settlement.
• Medicare, Medicaid, and the State Health Plan have repayment rights separate from provider liens; do not apply the medical-provider lien cap to these without verification.
• Out-of-network or vendor bills (radiology, anesthesia, DME) are easy to miss; request a comprehensive ledger from each facility.
• Watch for duplicate or premature collection activity; keep everything in writing and ask providers to pause collections while insurance reprocesses.
• ERISA/self-funded health plans may assert strong contractual subrogation; review plan documents and obtain written resolution.

Talk to a Personal Injury Attorney

If you're dealing with medical bills and lien questions after treatment, 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.