North Carolina Surprise Billing Law

Overview

North Carolina HB 278 (2019) and the federal No Surprises Act together protect patients from surprise bills. Emergency services are protected under HB 278. Non-emergency out-of-network services at in-network facilities are covered under federal NSA. The North Carolina Department of Insurance handles complaints and enforcement for both.

Key Requirements

1. Emergency services at any facility are protected from balance bills under HB 278.
2. Non-emergency OON services at in-network facilities receive NSA-level protections.
3. Good faith estimates must be provided 21 days before scheduled services.
4. Patients must receive clear notice of surprise billing rights and protections.
5. Insurers must address patient complaints within 30 days under NSA timelines.

Penalties and Enforcement

North Carolina Department of Insurance enforces both HB 278 and federal NSA compliance. Violations result in state fines and enforcement actions. CMS enforces NSA at the federal level. Providers who bill for protected services without valid exceptions face penalties. State and federal enforcement coordinate to prevent violations.

Appeals and Exceptions

Surprise billing protections apply to emergencies (HB 278) and NSA-covered OON services. Elective out-of-network care and non-emergency services lacking NSA coverage are not protected. Federal NSA protections provide supplemental coverage for non-emergency services.

Interaction with Federal Law

Federal NSA and state HB 278 work together in North Carolina. HB 278 covers emergency services; NSA covers many non-emergency scenarios. NC DOI coordinates with CMS. When federal and state law conflict, the more protective standard applies.

Common Questions