Short Answer

Yes. In North Carolina, you can open and pursue your auto policy’s medical payments (med-pay) claim even if you are unsure whether you have Medicare, Medicaid, or private health insurance. Med-pay is first-party coverage that can pay reasonable crash-related medical bills regardless of fault. If you are on Medicare or Medicaid (or a health plan with reimbursement rights), you must coordinate and resolve any required paybacks from med-pay funds before you keep the balance.

Understanding the Problem

You were hurt in a North Carolina crash and haven’t filed the med-pay claim yet. You don’t know whether you have Medicare, Medicaid, or private insurance. You want to know if you can start a med-pay claim now and what you must do to avoid problems with benefit programs later.

Apply the Law

Under North Carolina law, med-pay is optional, first-party auto insurance that reimburses the insured’s reasonable, necessary medical expenses caused by a covered crash, up to the policy limit. It is separate from liability coverage and pays without regard to fault. If the injured person has Medicare, Medicaid, or certain health plans with reimbursement or subrogation rights, those programs may have a legal claim against any insurance proceeds related to the injury (including med-pay). You can still file the med-pay claim now; you just need to notify and resolve any statutory or contractual reimbursement before disbursing funds.

Key Requirements

• Covered person and covered expense: You are an insured under the auto policy, and the bills are reasonable, necessary, and caused by the crash.
• Policy compliance: You give prompt notice, submit proof of loss (itemized bills/records), and meet any policy time limits for med-pay.
• Causation window: Treatment occurs within the policy’s stated timeframe after the crash (often months to a few years, per policy).
• Coordination of benefits: If you are (or become) a Medicare or Medicaid beneficiary—or are on a plan with reimbursement rights—you notify them, confirm any lien/claim amount, and repay from med-pay as required.
• Documentation and segregation: Track bills, Explanation of Benefits (EOBs), and keep med-pay funds separate until any required paybacks are resolved.

What the Statutes Say

• North Carolina Gen. Stat. § 108A-57 (Medicaid lien and subrogation) - The State may assert a claim for Medicaid-paid medical expenses from injury-related insurance recoveries.
• North Carolina Gen. Stat. § 135-48.37 (State Health Plan reimbursement) - The State Health Plan has reimbursement/subrogation rights against third-party recoveries.
• North Carolina Gen. Stat. § 1-52 (Three-year limitation for contract actions) - Contract claims generally must be brought within three years; policy-specific deadlines still apply.

Analysis

Apply the Rule to the Facts: Your ambulance and ER bills are classic med-pay items, and ongoing treatment may also qualify if crash-related and within your policy’s time window. You can open the med-pay claim now and submit itemized bills. Because your insurance status is unknown, set up safeguards: if you learn you are on Medicare or Medicaid (or another plan with reimbursement rights), notify them, confirm any lien/claim, and repay them from med-pay before keeping the remainder.

Process & Timing

1. Who files: You (or your attorney). Where: Your auto insurer’s claims department. What: Notice of claim, policy number, crash date, itemized medical bills/records, and a HIPAA authorization; your insurer may request EOBs. When: Give prompt notice; most policies require timely proof of loss, and contract claims are generally subject to a three-year limit from breach—policy deadlines can be shorter, so act now.
2. Coordination: If you are on Medicare, contact the Benefits Coordination & Recovery Center to open a conditional payment file; if you are on NC Medicaid, notify the Department of Health and Human Services’ third-party recovery unit. Private plans often require notice under plan reimbursement clauses. Expect lien/claim updates to take weeks to months.
3. Disbursement: When med-pay issues payment, hold enough funds to satisfy any Medicare/Medicaid/plan claim. Obtain a final demand (or waiver/reduction if applicable), repay, and keep the balance. Your insurer may pay providers directly or reimburse you—follow your policy.

Exceptions & Pitfalls

• Unreported benefits: Failing to notify Medicare/Medicaid (or a plan with reimbursement rights) can delay resolution and may trigger interest or other enforcement.
• Double payment traps: If a health plan pays first, med-pay may reimburse your out-of-pocket portions; keep EOBs to prove what remains unpaid.
• Policy timing: Some med-pay policies require treatment within a set period after the crash; missing that window can bar payment even if bills are crash-related.
• Documentation gaps: Insurers may deny or delay payment without itemized bills, records, or proof that care is crash-related.

Talk to a Personal Injury Attorney

If you're dealing with an auto med-pay claim and possible Medicare, Medicaid, or private plan reimbursement, 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.