House committee substitute to the 1st edition makes the following changes.
Amends GS 8-58.1(a) (injured party as witness when medical charges at issue) as follows. Specifies that the testimony of a person pursuant to GS 8-58.1 establishes a rebuttable presumption of the reasonableness of the amount paid or required to be in paid in full satisfaction of the charges.
Amends GS 8-58.1(b) to now provide that if the injured party has health insurance that will, if filed by a particular health care provider (was, just provider), result in a reduction in the charge due to a contractual adjustment being taken by the provider, and such health insurance (was, just insurance) is filed and no lien as set forth in GS 44-49 or GS 44-50 has been asserted, then the evidence as to the amount of the bill will be the amount paid by all sources and all amounts remaining to be paid. Now specifies that if a lien under GS 44-49 or GS 44-50 has been asserted, regardless of any defenses against the lien (previously, no mention of defenses against the lien), and the injured party has no health insurance or no health insurance (was, insurance) has been filed, then the evidence as to the amount of the charge that may be introduced in an action tried in the courts of North Carolina is the amount of the claimed lien plus any amounts paid toward the balance of the original charges and any amounts due not included in the lien (was, just the amount of the claimed lien). Now provides that if the injured party is covered by Medicare, Medicaid, or any health plan or program (was, just Medicare and Medicaid), and such benefit provider chooses to pay the claim, the evidence of the amount of the charge shall 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. Specifies that the rule does not impose upon the inured party an affirmative duty to seek a reduction in billed charges or submission of charges to a health insurer.
Makes organizational and technical changes to GS 44-49(b) (pertaining to certain medical liens).
Amends the unfair claims settlement practices set forth in GS 58-63-15(11) (unfair competition and unfair trade practices in insurance) as follows. Changes new GS 58-63-15(11)(p) so that the unfair practice is attempting to calculate the amount of a health care provider charge for the purpose of determining damages in a claim by a method other than that set forth in GS 8-58.1 as amended (previously applied to medical provider charges for a purpose other than an action tried in the State with certain exceptions). Adds new GS 58-63-15(11)(q) making it an unfair practice to apply GS 8C-1, Rule 414 or GS 8-58.1 to calculate a health care provider charge in any matter governed by Article 45C of GS Chapter 1, Revised Uniform Arbitration Act, or not governed by the Rules of Evidence.
Makes conforming changes to act’s long title.
Bill Summaries: H 161 PROTECTING PROPERLY INSURED INDIVIDUALS.
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Bill H 161 (2023-2024)Summary date: Apr 19 2023 - View Summary
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Bill H 161 (2023-2024)Summary date: Feb 21 2023 - View Summary
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 44-49, 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.