Short Answer

Yes—under North Carolina practice, you can ask the hospital’s billing office for written confirmation that the hospital account for a specific emergency-room date of service shows a $0 patient balance and no further patient billing is expected. North Carolina law also gives patients the right to request an itemized list of hospital charges, which can help confirm whether anything is missing from the hospital’s statements. Keep in mind that an ER visit often generates separate “facility” (hospital) charges and “professional” charges (emergency physician or other providers) that may not be on the hospital’s bill.

Understanding the Problem

If you had an emergency-room visit in North Carolina and the hospital says the account is “zero balance,” can you get something in writing confirming the hospital’s bill is fully paid and closed out for that date of service, especially where your file review shows an ER visit statement and you want to make sure nothing is missing?

Apply the Law

North Carolina requires hospitals to follow certain fair billing practices. A key practical tool is the patient’s right to request an itemized list of hospital charges, in plain language, for a period that can extend up to three years after discharge (and longer if the hospital or a collector still claims money is owed). While the statute focuses on itemization and dispute/collection practices—not a mandatory “paid in full” letter—hospitals commonly can provide a written account statement or letter showing a $0 balance for the hospital account tied to a specific date of service.

In personal injury cases, written billing confirmation also matters because medical providers can assert liens against a personal injury recovery. North Carolina’s medical lien statute ties lien validity (when requested by the injured person’s attorney) to the provider giving an itemized statement/record/report and written notice of any lien claimed. So, when a hospital says “zero balance,” it is still reasonable to ask whether the hospital is claiming any lien and to request written confirmation of the current balance status.

Key Requirements

• Correct account scope (hospital vs. professional billing): Confirm you are asking about the hospital “facility” account for the ER date of service, and separately confirm whether any emergency physician or other professional groups billed under different tax IDs/accounts.
• Written, patient-authorized request: The hospital can require a signed patient authorization before releasing billing details to a law firm or other third party.
• Itemized hospital charges on request: If the statement is unclear, the patient can request an itemized list of charges in plain language to verify what the hospital billed for that visit.
• Ask about liens, not just balance: A “$0 patient balance” is different from “no lien claimed” in a personal injury file; ask the hospital to confirm whether it is asserting any lien related to that date of service.
• Keep the date-of-service specific: Use the exact ER date of service and the hospital account number(s) so the response does not accidentally cover the wrong encounter.

What the Statutes Say

• N.C. Gen. Stat. § 131E-91 (Fair billing and collections practices) - Gives patients the right to request an itemized list of hospital charges and requires hospitals to have a method to inquire about or dispute a bill.
• N.C. Gen. Stat. § 44-49 (Medical provider liens in personal injury cases) - Creates a lien on personal injury recoveries for certain medical charges and requires itemized information and written lien notice to the injured person’s attorney upon request as a condition to a valid lien.
• N.C. Gen. Stat. § 44-50 (Duty to retain funds after notice of lien claims) - Addresses how lien claims can attach to settlement funds and the obligation to retain funds after notice of claims.

Analysis

Apply the Rule to the Facts: Here, the provider indicates the hospital and any physician-related billing for the ER date of service were processed through the client’s health coverage and the account shows a zero balance. Under North Carolina’s hospital billing rules, the client (or the client’s authorized representative) can request an itemized list of the hospital’s charges to confirm nothing is missing on the hospital side. And because ER care often involves separate billing streams, it is reasonable to request written confirmation that (1) the hospital facility account is at $0 and (2) the hospital is not asserting any lien related to that date of service.

Process & Timing

1. Who files: The patient or the patient’s authorized representative (often the law firm with a signed authorization). Where: The hospital’s billing office (patient financial services) in North Carolina. What: A written request for (a) an itemized statement for the ER date of service and (b) a “zero balance/paid in full” account statement or letter for the hospital facility account, plus confirmation whether any lien is claimed. When: Request the itemized hospital charges any time within three years after discharge (and potentially longer if the hospital or a collector still claims money is owed).
2. Follow up for separate billing: Ask the hospital to identify whether emergency physician services were billed by a separate entity and, if so, the contact information for that billing office (because the hospital may not control professional billing statements).
3. Document the file: Keep the written response (or zero-balance statement) with the date-of-service and account number so you can show what was requested and what the hospital confirmed.

Exceptions & Pitfalls

• “Zero balance” may mean “zero patient responsibility,” not “no charges exist”: Insurance may have paid, adjusted, or denied items; an itemized statement helps confirm what was billed and how it was resolved.
• Hospital vs. emergency physician billing: A hospital can confirm its own facility account, but it may not be able to certify that all professional bills (ER physician, radiology, pathology) are closed unless those providers bill through the hospital.
• Account matching problems: ER visits can generate multiple account numbers (facility, observation, imaging). If the request does not list the correct date of service and identifiers, you can get an incomplete confirmation.
• Lien questions are separate from balance questions: In a personal injury case, ask specifically whether the hospital is asserting any lien related to the date of service, not just whether the patient balance is $0.
• Authorization issues: Without a proper patient authorization, the hospital may limit what it will provide to a law firm.

Conclusion

In North Carolina, you can request written confirmation from the hospital’s billing office that the hospital facility account for a specific ER date of service shows a $0 patient balance and no further patient billing is expected. You can also request an itemized list of the hospital’s charges to confirm the statements are complete. Next step: send a written, patient-authorized request to the hospital billing office for an itemized statement and a zero-balance account statement for that date of service within three years after discharge.

Talk to a Personal Injury Attorney

If you’re dealing with an ER visit bill in a North Carolina injury claim and need to confirm whether all facility and professional charges are accounted for (and whether any lien is being claimed), our firm has experienced attorneys who can help you understand your options and timelines. Reach out today.

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.