Medical bill errors and your rights in North Carolina

North Carolina state law

North Carolina itemized hospital bill on request

North Carolina directs all licensed hospitals and ambulatory surgical facilities to present, upon the patient's request, an itemized list of charges in language comprehensible to an ordinary layperson. A bill that is not itemized must notify the patient of the right to request an itemized bill free of charge.

What you can do: Request the free itemized bill and reconcile each line item and code against the services received; the facility must also maintain a method for the patient to inquire about or dispute the bill.

Citation: N.C. Gen. Stat. § 131E-91 · effective 1991-10-01

Federal law

No Surprises Act good-faith estimate & patient-provider dispute

Uninsured and self-pay patients are entitled to a good-faith estimate of expected charges before scheduled care. If the final bill from a provider exceeds the good-faith estimate by at least $400, the patient may initiate the patient-provider dispute resolution (PPDR) process.

What you can do: Compare the good-faith estimate to the final charges; where the bill exceeds the estimate by $400 or more, dispute the coding and charges and, if applicable, initiate the federal patient-provider dispute resolution process within 120 days of the bill.

Citation: No Surprises Act, PHS Act § 2799B-6; 45 C.F.R. § 149.610–.620 · effective 2022-01-01

Federal law

Section 501(r) financial-assistance & charity-care policy

Tax-exempt nonprofit hospitals must maintain a written financial-assistance policy (FAP), limit amounts charged to FAP-eligible patients to no more than amounts generally billed (AGB) to insured patients, and refrain from extraordinary collection actions before making reasonable efforts to determine FAP eligibility.

What you can do: Apply for financial assistance under the hospital's FAP within the application period (at least 240 days from the first post-discharge billing statement) and require charges be limited to amounts generally billed.

Citation: 26 U.S.C. § 501(r); Treas. Reg. § 1.501(r)-4, -5, -6 · effective 2016-01-01

Federal law

Fair Debt Collection Practices Act — debt validation

When a debt is with a third-party collector, the consumer may dispute the debt and request validation. On a timely written dispute, the collector must cease collection until it mails verification of the debt.

What you can do: Send a written debt-validation request disputing the debt; the collector must cease collection activity until it mails verification of the debt.

Citation: Fair Debt Collection Practices Act § 809, 15 U.S.C. § 1692g · effective 1977-09-20

Where to report a billing problem in North Carolina

If a hospital or insurer won’t correct a bill that breaks the rules above, you can report it to the government offices that enforce them. Filing a complaint is free, and these offices can spot patterns even when they can’t resolve a single bill. Reporting is not a guarantee of any outcome, and this is general information, not legal advice.

North Carolina agencies

• North Carolina Dept. of Justice — File a Consumer Complaint
• North Carolina Department of Insurance — File a Complaint

Federal help

• Consumer Financial Protection Bureau (CFPB) — submit a complaint about medical bills or debt collection
• No Surprises Act help (federal CMS) — surprise bills and good-faith estimates

Think the law itself should be stronger? You can find and contact your North Carolina state legislators to share your experience.