NCHA Statement on North Carolina State Treasurer Report on Hospital Lawsuits Over Medical Debt

Raleigh, NC – August 16, 2023 – North Carolina hospitals and health systems are united in placing patients and families at the center of everything we do. As a field, we strive to deliver care for all people with dignity and compassion. This commitment is demonstrated every day as we deliver our best for everyone who walks through our doors, regardless of what an individual looks like, where they are from, their politics, or their ability to pay. In fact, hospitals spend roughly $92,085.00 every minute in North Carolina on community benefits or $48.4 billion dollars annually.  

Quality and cost of care are top of mind for hospitals, physicians and all members of the healthcare team. All of North Carolina’s hospitals have generous and transparent financial assistance policies and actively work with patients to discuss and address their financial constraints. They offer discounts and robust charity care policies. They have dedicated staff who assist individuals who have questions about their medical bills, or who are concerned about how their bill might affect their financial situation. And hospitals make these services and resources known to patients. 

North Carolinians may be eligible for financial assistance if they do not have insurance, are under-insured, or if it would be a financial hardship to pay full out-of-pocket expenses for medically necessary care.  

Despite our best efforts, there are many patients who have insurance plans that significantly contribute to medical debt. High deductible plans, narrow networks, and restrictive policies that prevent timely care compound this problem. Some patient debt can also be incurred when patients who would otherwise qualify for financial assistance decline to apply or do not go all the way through to complete the process of qualifying for assistance. Hospitals work with these patients to establish an affordable payment plan.  

In addition, numerous studies have shown that residents of states that did not expand Medicaid are more likely to have significant medical debt. 

Hospitals and health systems work to actively help patients navigate a complicated and fragmented billing system. Hospitals, just like patients, must work with insurance companies to seek permission to care for those covered and must work with insurers to ensure bills get paid. This system creates a daily balancing act for patients, families and their healthcare partners such as health systems and hospitals who are trying to do good for them. 

Here are some reasons why some individuals face health care expenses beyond their ability to pay: 

Hospitals need to be able to maintain their mission to the community and be there, always, for those who need us. Hospitals bill insurance companies, governmental payers, and those patients who have an ability to pay. When they seek to collect payments on debts owed, North Carolina hospitals follow federal IRS guidelines and their own financial assistance policies to guide the staff as they work with patients and families to ensure all are treated with dignity and respect throughout the patient financial experience process. 

About NCHA 

Founded in 1918, North Carolina Healthcare Association (NCHA) is the united voice of the North Carolina healthcare community. Representing more than 130 hospitals, health systems, physician groups and other healthcare organizations, NCHA works with our members to improve the health of North Carolina communities by advocating for sound public policies and collaborative partnerships and by providing insights, services, support, and education to expand access to high quality, efficient, affordable, and integrated health care for all North Carolinians.  

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