The Hospital Bill
G.S. 131E-91 — an itemized bill on request, and 30 days' notice before collections
In North Carolina, a hospital or ambulatory surgical facility presents an itemized list of charges in plain language on request. A patient may ask any time within three years after discharge, or as long as anyone asserts the bill is owed, and a bill that is not itemized says the patient may request one free of charge.
- No referral to collections while the patient's charity care or financial assistance application is pending.
- Written notice at least 30 days before a bill is referred to collections.
- A collections agency tells the patient about the charity care and financial assistance policies, and gets the facility's written consent before filing a lawsuit.
The home is protected. No lien from a judgment for such a debt attaches to a principal residence held by spouses as tenants by the entireties, or, on land over five acres, to the residence and the surrounding five acres. For care given to a minor, the custodial parents' principal residence is not sold on execution until the minor no longer lives there or reaches the age of majority.
Refunds and insurance. An undisputed overpayment is refunded within 45 days of notice of it, and an insured patient is not billed for charges the insurance would have covered had the facility filed the claim on time.
| The assumption | What the law actually does |
|---|---|
| The assumptionA hospital can send a bill to collections without warning | What the law actually doesWritten notice at least 30 days before referral |
| The assumptionAn itemized bill is available only right after discharge | What the law actually doesOn request, any time within three years after discharge |
Insurance appeals, surprise billing rules and the federal rules for nonprofit hospitals are not all on this page. Whether a particular bill qualifies, or a particular collection step was allowed, is a question for a licensed North Carolina attorney.
Sources for this section (1)
- G.S. 131E-91 — Fair billing and collections practices for hospitals and ambulatory surgical facilities
Legal information, not legal advice. Verified as of September 2026. Applying it to a particular situation is the work of a licensed North Carolina attorney.