NC law bans billing sexual assault survivors, insurance for exams. Why it still happens
North Carolina is considering imposing a significant penalty on hospitals that bill sexual assault victims’ insurance companies for tests rather than sending them to the state.
State law requires the hospitals to send the bills to the Department of Public Safety, which pays them using federal funds.
But emails between the state treasurer’s office and Blue Cross Blue Shield, obtained by The News & Observer through a public records request, show that dozens of hospitals and medical offices across the state may have been sending the bills to patients’ insurance companies instead of DPS.
The North Carolina Coalition Against Sexual Assault has been advocating for stricter requirements for a decade. Its executive director, Monika Johnson-Hostler, told The News & Observer on Thursday that North Carolina hasn’t been able to solidify how all hospitals can be responsible for billing correctly.
“As an advocate, it’s not about the penalty but about culture,” she said, and changing it so hospitals know exactly what medical billing code to enter and to always send bills directly to DPS.
Johnson-Hostler said sexual assault is already traumatic for survivors without also having to pay an insurance co-pay or, if they are a college student, having the information sent to their parents’ insurance.
Medical debt, medical issues and lack of health insurance “compound that with the trauma of sexual assault,” she said.
House Bill 626, which passed the House on a unanimous 111-0 vote in May 2021, would change the law regulating the assistance program for rape and sex offense victims to clarify the term “forensic medical examination” and require DPS to penalize hospitals and medical offices that bill a victim, their private insurance or Medicaid or Medicare for the cost. The bill could see legislative action this month before the end of the short session.
Blue Cross Blue Shield
Earlier this year, State Treasurer Dale Folwell’s office asked Blue Cross Blue Shield to look into bills it received for forensic exams related to sexual assault and rape kits, which collect evidence.
Blue Cross Blue Shield found that in 2021, “there were 92 claims submitted for services which, based on the diagnosis, could have been a forensic exam,” according to an email between BCBS and the treasurer’s office. The claims provided were limited to emergency department visits using diagnostic codes that the insurance company said would most commonly have been seen on an exam claim. BCBS noted that it was just an assumption, as there is not a specific procedure code for the exam.
HB 626 could change that. According to the bill, a medical facility or professional that bills the victim or insurance for the examination would have to pay a civil penalty of $25,000 for each violation.
Blue Cross Blue Shield’s assessment of the 92 claims show they were from 60 providers total — 42 facilities and 18 that were physician groups. It included major hospitals across the state.
Johnson-Hostler said making a specific code for the exams would mean that a patient will know what the code means, and the insurance companies too, so that data collection is also easier.
The state’s Rape Victim Assistance Program pays for the cost of forensic exams. Contact the program at 800-826-6200 or at 919-733-7974.
The Victim Assistance Program paid for 1,376 sexual assault claims in the 2020-21 fiscal year, according to an email between DPS and the treasurer’s office obtained by The N&O. Of those, 963 were for adult sexual assault and 413 for sexual abuse of children.
For immediate support or assistance, call 911, call the National Sexual Assault Hotline at 800-656-4673 or visit nccasa.org/get-help/.
For more North Carolina government and politics news, listen to the Under the Dome politics podcast from The News & Observer and the NC Insider. You can find it at https://campsite.bio/underthedome or wherever you get your podcasts.
This story was originally published June 9, 2022 at 7:08 PM with the headline "NC law bans billing sexual assault survivors, insurance for exams. Why it still happens."
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