How does pre-demand verification of medical visits and costs work?: A North Carolina personal injury guide

Woman looking tired next to bills

How does pre-demand verification of medical visits and costs work? - North Carolina

Short Answer

In North Carolina, pre-demand verification means your attorney gathers and confirms your medical treatment dates, itemized bills, and any healthcare liens before sending a settlement demand. The attorney cross-checks records and balances with every provider and insurer, applies North Carolina’s medical lien rules, and prepares an itemized summary for the claims adjuster. This step helps avoid surprises, supports the reasonableness and necessity of charges, and can speed up negotiations.

Understanding the Problem

You want to know how, in North Carolina, your injury attorney can verify your medical visits and costs before making a settlement demand to the insurer. Because you treated at multiple facilities, your attorney plans to prepare a single pre-demand verification that lists treatment dates and costs. This article explains what is gathered, how it is checked, and why it matters to your claim.

Apply the Law

Under North Carolina law, healthcare providers may assert statutory liens on personal injury recoveries for their reasonable charges, and attorneys must account for those liens when distributing settlement funds. Before sending any demand, attorneys verify records and bills, reconcile payments from health insurance/Medicare/Medicaid, and apply the statutory cap on medical liens. Attorneys also organize the information to show that charges are reasonable and related to the incident so it is usable in negotiations and, if needed, in court. The process is handled pre-suit with the insurer; no court filing is required at this stage.

Key Requirements

  • Complete records and bills: Request itemized medical records and itemized statements from every provider to confirm dates of service, CPT/HCPCS coding, and outstanding balances.
  • Lien identification: Identify and confirm any statutory medical liens and subrogation claims (providers, health insurers, Medicare/Medicaid) tied to your injury.
  • Reasonableness and necessity: Organize bills and records so they show treatment was related to the incident and charges are reasonable; obtain provider affidavits or business-records certifications when useful.
  • Distribution cap: Apply North Carolina’s cap on total provider liens out of the recovery after attorney’s fees.
  • Accurate summary: Prepare a consolidated ledger of providers, dates, diagnosis codes (if needed), amounts billed/paid/adjusted, balances, and lien status for the demand package.

What the Statutes Say

Analysis

Apply the Rule to the Facts: Because you treated at multiple facilities, your attorney will request itemized records and bills from each provider and reconcile them against any insurance payments. That satisfies the completeness and lien-identification steps. Next, the attorney organizes the data to show the treatment was related to your injury and the charges are reasonable, supporting negotiations. Finally, the attorney applies North Carolina’s lien cap to estimate how much of any settlement must go to providers versus your net recovery, and then summarizes everything in a clear ledger for the adjuster.

Process & Timing

  1. Who files: Your attorney. Where: Requests go directly to your providers, insurers, and benefit plans; the verification goes to the liability insurer’s adjuster. What: HIPAA-compliant authorizations; requests for itemized medical records and itemized bills; insurance explanations of benefits; a pre-demand verification letter with a provider-by-provider ledger. When: Record requests typically go out immediately; providers commonly respond within several weeks, but timing varies.
  2. Reconcile and confirm: Your attorney cross-checks records, writes to providers to confirm balances and lien status, and requests reductions when appropriate. This often takes 2–4 weeks depending on provider responsiveness.
  3. Finalize and send demand: After verification, your attorney sends the settlement demand with the itemized ledger, supporting records, and lien calculations so the adjuster can evaluate promptly.

Exceptions & Pitfalls

  • Missing providers or facilities can lead to surprise liens later; confirm every location, specialist, and imaging vendor.
  • Request itemized bills, not just statements; itemization is often needed to prove reasonableness and to correct coding or balance errors.
  • Do not overlook subrogation (Medicare/Medicaid/private health plans); failure to address these can delay payment and create penalties.
  • Use current balances; outdated statements can overstate what is owed after insurance adjustments.
  • Apply the statutory lien cap correctly and seek fair reductions where appropriate before sending the demand.

Conclusion

In North Carolina, pre-demand verification means your attorney collects itemized records and bills from each provider, confirms any liens or subrogation claims, and applies the state’s lien cap before sending a demand. The goal is a clean, accurate ledger that proves treatment was related and charges are reasonable. The next step is to request complete itemized records and bills from all providers and confirm balances before submitting your demand.

Talk to a Personal Injury Attorney

If you're dealing with medical bills, liens, and insurance after an injury, 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.

Categories: 
close-link