Short Answer

In North Carolina, confirm the hospital’s balance in writing before you disburse any settlement funds. Ask the hospital’s Patient Financial Services or lien department for a final, itemized statement and a written zero-balance or lien-satisfaction letter tied to the date(s) of service. North Carolina law allows hospitals to assert liens on injury recoveries, so do not settle or disburse until all asserted liens or balances are verified and resolved in writing.

Understanding the Problem

You want to know if you can safely settle a North Carolina personal injury case without any surprise hospital bills showing up later. As the patient’s attorney, you’ve already sent medical billing authorizations and requested an itemized statement for the hospital treatment on the date in question. The decision point is whether you have reliable, written confirmation from the hospital that no charges are pending or owed before you disburse settlement funds.

Apply the Law

North Carolina law lets hospitals and other medical providers claim a lien on injury settlements for reasonable charges related to the treatment. A provider typically perfects its lien by giving written notice to the attorney or insurer before funds are disbursed. Providers must furnish itemized statements on request in connection with an injury claim, and lien payments are subject to statutory limits and distribution rules. The practical “forum” is the hospital’s Patient Financial Services or lien unit; there is no courthouse filing to perfect a hospital lien. The key timing trigger is before settlement disbursement—resolve any lien or balance you have notice of and get written confirmation of the final account status.

Key Requirements

• Hospital lien exists only if noticed: The hospital must give written notice of its lien before funds are disbursed.
• Itemized bill on request: On a pending injury claim with proper authorization, the hospital should provide an itemized statement so you can verify charges.
• Reasonable, related charges: Only reasonable charges for treatment related to the injury are lien-eligible.
• Statutory payout limits apply: North Carolina law caps and orders how much of the settlement can go to providers asserting liens.
• Don’t disburse with notice: If you have notice of a hospital lien, resolve it first or obtain a written waiver/satisfaction before paying out funds.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider liens) - Allows hospitals and other providers to claim a lien on personal injury recoveries and addresses notice and records.
• North Carolina Gen. Stat. § 44-50 (Distribution and limits) - Sets how settlement funds are distributed and limits the amounts payable to lienholders.

Analysis

Apply the Rule to the Facts: You already sent billing authorizations and asked for an itemized statement. Next, get the hospital’s written confirmation of the final balance for the specific date(s) of service and ask whether any “late charges” or coding adjustments are pending. If the hospital asserted a lien, obtain a lien payoff and then a written lien satisfaction or zero-balance letter. If no lien was noticed and the account is zero, document that in writing before disbursing.

Process & Timing

1. Who files: The attorney. Where: Hospital Patient Financial Services or lien department in North Carolina. What: Send a HIPAA-compliant authorization, any assignment used, and a written request for (a) a final itemized statement for the date(s) of service, and (b) a written zero-balance or lien-satisfaction letter. When: Before signing the release or disbursing settlement funds.
2. Confirm whether the account is “final coded” and whether any late charges or adjustments are pending; follow up weekly until the hospital confirms a final balance in writing. If a lien was noticed, request a payoff good-through date and then a written satisfaction after payment.
3. Once you receive the final itemized statement and written zero-balance or lien-satisfaction letter for each account number/date of service, document your file and proceed with settlement disbursement consistent with statutory limits.

Exceptions & Pitfalls

• Late charges and coding updates can post after discharge; ask if the account is final and whether any late charges are pending.
• Separate billing entities (e.g., radiology, lab, anesthesia, EMS) may not be included on the hospital’s bill—confirm each account and provider for the same date(s) of service.
• If the hospital never sent written lien notice, it may lack lien rights against settlement funds—but the patient may still owe the bill; get clarity in writing.
• If a provider refuses to furnish an itemized bill or to work with a standard assignment in an injury claim, that can affect lien rights; escalate to a supervisor and document responses.
• Distinguish hospital balances from health plan subrogation or government program reimbursement; they follow different rules and timelines.

Talk to a Personal Injury Attorney

If you’re trying to verify hospital balances and lien claims before settling an injury case, our firm has experienced attorneys who can help you understand your options and timelines. Reach out today: (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.