Substantively identical to S 476, filed 4/1/21.
Regarding testimony by an injured party in a civil proceeding regarding evidence as to medical charges paid or required to be paid in full satisfaction of the charges under GS 8-58.1, eliminates the rebuttable presumption established by such a testimony as to the reasonableness of the amount paid or required to be paid in full satisfaction of the charges. Instead, enacts the following. Requires that, if the injured party has health insurance that will, if filed by a particular provider, result in a reduction in the charge due to a contractual adjustment being taken by the provider, and such insurance is filed and no lien as set forth in GS 44-49 or GS 44-50 has been asserted (governing liens on recovery for personal injuries to secure sums due for medical attention), then the evidence as to the amount of the bill must be the amount paid by all sources and all amounts remaining to be paid. Requires that, if a lien under GS 44-49 or GS 44-50 has been asserted, and the injured party has no health insurance or no insurance has been filed, the evidence amount of the charge to be introduced in an action tried in NC courts must be the amount of the claimed lien. Requires that, if the injured party is covered by Medicare or Medicaid, and such benefit service provider chooses to pay the claim, the evidence of the amount of the charges must be the amount actually paid by the benefit provider and, if any, the amount paid by or on behalf of the injured party from any source and any amount left unpaid. Provides that these provisions do not change, modify, or alter the provisions of GS 44-50.
Amends the provisions providing criteria for the invalidity of a lien under GS 44-59, which governs liens on recovery for personal injuries to secure sums due for medical attention. Provides for invalidity if (1) the person entitled to the lien does not furnish, without charge to the attorney as a condition precedent to the creation of the lien, upon request to the attorney representing the person in whose behalf the claim for personal injury is made, an itemized statement, hospital record, or medical report for the use of the attorney in negotiation, settlement, or trial of the claim arising by reason of the personal injury, and written notice to the attorney of the lien claimed (same as existing law) or (2) the health care provider does not timely submit a claim to an injured party's health insurer or health plan within the allotted time requirements of the health insurer, health plan, or health program. Makes technical changes.
Adds to the general business practices that constitute unfair claim settlement practices under GS 58-63-15, thus included as unfair methods of competition and unfair and deceptive acts or practices in the business of insurance: (1) attempting to calculate the amount of a health care provider charge by any method other than that set forth in GS 8-58.1, as amended, and (2) attempting to calculate the amount of a medical provider charge for a purpose other than an action tried in NC courts, with the exception of arbitrations or other matters where the Rules of Evidence do not apply, by any method other than that set forth in GS 8-58.1, as amended.
Bill H 539 (2021-2022)Summary date: Apr 13 2021 - View summary