Fee gets added to questionnaires at some health care systems
Plus: RTO outlook for 2026; Will stablecoins threaten traditional lenders?; Toppman reviews 'Scrooge in Rouge'; Blue Line stabbing gets national attention; West Charlotte football coach out
Today is Monday, December 8, 2025. You’re reading The Charlotte Ledger, an e-newsletter with local business-y news and insights for Charlotte, N.C.
Good morning, Ledger readers, it’s Ashley. We’re at that point in the year where we start seeing look-backs on the big stories of 2025 — and try to read the cards about what’s in store for 2026. Charlotte’s business world this year had plenty of headlines, whether it was Atrium Health’s The Pearl innovation district opening (and questions around its affordable housing commitments there), big jobs announcements like Scout Motors or the Queens-Elon merger. I’ll be talking about some of those 2025 headlines on “Charlotte Talks” this morning, alongside Erik Spanberg at the Charlotte Business Journal and Ely Portillo at WFAE.
What’s on your bingo card for Charlotte in 2026? Let me know.
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Novant Health has started charging patients for self-administered surveys that screen for problems. Patients say they should not be billed for checking a few boxes.
by Michelle Crouch
When Steve Hardman of Charlotte checked in to see a Novant Health sleep doctor earlier this year, the receptionist handed him a survey to fill out.
Hardman, 66, had seen the questions before: Do you feel safe in your house? Can you afford food? He spent a few minutes checking off the answers and handed the form back to the front desk.
A few weeks later, a bill from Novant arrived, and it included an extra $8 fee he hadn’t seen before.
Thinking it must be a mistake, Hardman called Novant’s billing office. The billing representative told him the fee was connected to the questionnaire he had completed.
Hardman was shocked, especially since no one at Novant had talked to him about the survey or his responses.
“You are asking people if they feel safe, if they can afford food. Then you charge them,” he said. “In what world does that actually make sense?”
He said it sounded like a strategy to boost revenue: “It’s only a small amount, but you multiply that by I-don’t-know-how-many patients — probably millions every year — and that’s a nice add to the bottom line.”
A national trend
Across the country, hospitals have started charging for self-administered questionnaires — brief surveys that screen for depression, food insecurity, domestic violence or other risks, said Caitlin Donovan, senior director at the Patient Advocate Foundation, a patients’ rights nonprofit.
The screenings are supposed to flag patients who need extra support, but many people don’t learn about any potential fees until the bill arrives.
Donovan said she has talked to patients from multiple states who are frustrated that they were billed for checking a few boxes. She said it’s part of a broader billing trend her organization has noticed of health care systems billing for items that used to be included in a visit, whether it’s a facility fee or a charge for messaging your doctor.
“They’re screening for mental health or safety, and that’s incredibly important, but it should be part of the fee for the visit, not an add-on,” Donovan said. “They know if it’s a small-enough amount, most people probably just pay it.”
Novant: Surveys help patients
When asked about the charges, a Novant Health spokesperson said in an email that the survey asking about safety, housing and food security became a billable service in 2024.
“Social determinants of health assessments uncover non-medical factors affecting well-being, connecting patients to social workers, community health workers, and local resources as appropriate,” she wrote.
For example, she explained, patients facing food insecurity are connected to food resources and, if it’s urgent, are provided with an emergency pack that includes a four-day supply of food. To date, Novant Health has provided nearly 16,000 emergency food packs, according to the email.
The hospital said most insurance providers cover the assessment, “and the majority of patients pay between $5 and $10.”
UNC Health and Cone Health do similar screenings, but do not charge separately for them, according to spokespeople at each hospital. Other North Carolina health care systems queried by the Charlotte Ledger/NC Health News did not respond in time for publication.
Different types of assessments
After Hardman posted about his experience on the NextDoor website, more than 153 people commented, including some with similar experiences.
“I was billed by them as well,” one woman wrote. “They charged my insurance company for their part and me the balance.”
Another shared a photo of a bill with a $17 fee and said, “They just asked the standard questions: Are you depressed? Have you had suicidal feelings?” she said. “And all of a sudden, there is a charge for it without any warning.”
Donovan said providers can bill for several different types of assessments. Some screen for so-called “social determinants of health,” like food and housing insecurity. Others screen for mental health problems like depression or anxiety.
Research shows mental health screening surveys can lead to earlier detection of mental health issues and more timely interventions. A 2022 study published in the Journal of Clinical Psychiatry found that routine use of brief screenings in primary care settings increased the identification of depression and anxiety disorders by 35%, leading to faster treatment initiation and improved outcomes.
Novant said in a statement that its emotional health assessment “plays a key role in identifying early signs of emotional or mental health concerns, allowing for timely support and intervention.”
Nearly 27% of patients who take the assessment screen positive for a potential mental health condition, the hospital said, “underscoring the importance of this screening and the care team’s follow-up.”
‘How was I supposed to know about the charge?’
Heidi Bass, 59, of Charlotte agrees the screenings are valuable, but she said what’s missing is transparency.
She said she discovered a $17 charge for a “brief emotional and behavioral health assessment” only after clicking through several screens to get a detailed breakdown of the bill for her annual physical at Novant earlier this year.
When she called to ask what the fee was for, she talked to several employees before one finally told her it was tied to the questionnaire she completed during the online check-in process.
“When I protested, they said, ‘You don’t have to fill it out.’ But how was I supposed to know about the charge?” she said. “In no other situations do we do something and only find out afterwards how much it costs.”
Some insurers won’t pay
Medical billing expert Adria Gross, CEO of New York-based MedWise Insurance Advocacy, said Medicare and Medicaid typically cover the cost of the screenings.
But some commercial insurers may decline to pay a separate fee because they expect such screenings to be “bundled” into the overall visit charge, she said, which means the additional cost would get passed along to the patient.
“Insurers will also deny payment if the screening is done too often or without documentation that someone reviewed the results,” she said. “It really varies from policy to policy.”
Patients with high-deductible commercial insurance plans may also have to pay out of pocket if they haven’t yet met their deductible.
Gross recommends that patients review their bills, question charges they don’t understand and ask for any they disagree with to be waived.
That’s what Hardman did, and he said Novant dropped the fee once he disputed it.
He already has a plan, he said, if a receptionist tries to hand him a survey at future appointments: “I’ll just decline it.”
Michelle Crouch covers health care. If you have tips or ideas for her, please shoot her an email at mcrouch@northcarolinahealthnews.org.
This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting focused on the Charlotte area.
➡️ You can support this effort with a tax-free donation. This coverage is supported by readers like you who value smart, transparent and independent reporting.
Today’s supporting sponsor is Landon A. Dunn, attorney-at-law in Matthews:
Return-to-office push gains momentum as job market tightens
Will 2026 be the year that heading to the office five days a week once again becomes the norm?
Recent data suggests that a reduction in remote and hybrid work arrangements could be in the offing next year, with the unemployment rate inching up and surveys showing that employers continue to want their workers to show up in person.
Coming out of Covid, the thinking had been that as long as workers had plenty of choices, companies would have to offer remote and hybrid office options unless they wanted an exodus of employees. But now, as the unemployment rate has risen and the number of open jobs has declined (nationally and in North Carolina), employers might feel more confident asking their workers to return — and workers may have fewer choices.
The national unemployment rate hit 4.4% in September, its highest level in four years. The Charlotte region’s unemployment rate was 4.1% in August, its highest mark in more than a year.
Last month, Truist said its staff will return to the office five days a week starting in January, including about 3,000 workers in the Charlotte area. Other companies nationally that have announced plans in recent weeks to go back five days in-person include Paramount, Instagram and Kroger, and others have ratcheted up the number of days required at the office, including NBCUniversal (to four days a week) and Microsoft (three).
An October survey of business leaders found that 13% plan to increase the number of days at the office next year, compared with just 5% who plan to reduce them, “signaling a continued shift toward stricter RTO policies,” the survey concluded.
In uptown, statistics show that the back-to-office recovery has mostly stalled since 2023. According to figures from Charlotte Center City Partners, the frequency of people working from uptown in the third quarter of 2025 was at 79% of pre-pandemic levels. That’s a big comeback from the depths of Covid, but only slightly better than the 75% measured in the spring of 2023, using anonymous cellphone location data.
Hot desk shortage? At Charlotte’s biggest banks — Bank of America and Wells Fargo — three days a week in the office remains the norm. Some bank workers privately express skepticism that the banks could accommodate their workers heading in more frequently because flexible office layouts adopted in recent years would leave few available work stations. —Tony Mecia
Post-GENIUS Act passage, it’s still TBD whether stablecoins will shake up the US banking system
The federal government has, for the first time, established a legal and regulatory framework for a type of cryptocurrency known as stablecoin — but there’s still plenty of work to be done before that method of payment becomes widely adopted, a leading Bank of America researcher said in a Charlotte speech last week.
Stablecoins are backed by a reserve of assets, like the U.S. dollar. Akin to their name, they’re widely viewed as more stable than traditional cryptocurrencies, which can wildly fluctuate based on market supply and demand. J.P. Morgan Global Research projects the stablecoin market could hit $500B to $750B in the coming years.
There are still questions about practical use cases and the level of realistic adoption of stablecoins. That will determine how much the cryptocurrency will or won’t disrupt the U.S. financial system and traditional lenders like banks, which rely heavily on deposits to fund their institutions.
Given Charlotte’s status as a major banking city, any major shakeup to how payments or deposits are done could force traditional lenders — including ones headquartered or with a large presence here — to rethink longstanding business practices.
The Guiding and Establishing National Innovation for U.S. Stablecoins — or GENIUS — Act that became federal law this summer provided a legal and regulatory framework for stablecoin payments, but more work is still to be done, said Ebrahim Poonawala, managing director of BofA Global Research and head of North American banks research, at a Charlotte Economics Club event on Dec. 3.
“Much like any other banking rules and regulations, you’re going to get a relatively in-depth proposal over the coming months,” he said, adding that it’s expected the FDIC will issue something before the end of the year. The FDIC will be responsible for approving, licensing and overseeing entities that seek to issue stablecoins.
By the first quarter of 2026, Poonawala said he expects additional rules will be proposed around how to regulate stablecoin issuers.
Foreign money transfers are seen as one potential logical use case for stablecoins. Right now, transferring money across international borders must go through multiple parties before reaching its final destination — stablecoins could potentially simplify that process, Poonawala said.
Amazon and Walmart are among the major companies that are said to be exploring introducing their own stablecoins. If a giant like Amazon were to introduce its own stablecoin and incentivize consumers to use that cryptocurrency through rewards, that would probably speed up stablecoin adoption, he said.
Companies that deal with a high volume of transactions could be motivated to introduce their own stablecoins to bypass credit-card processing fees.
If major companies get into the stablecoin game, that could be a big disruptor for more traditional cash and card transactions — and pose a threat to legacy financial institutions. Stocks of Visa and Mastercard took a hit after news reports earlier this year said Amazon, Walmart, Expedia Group and some airlines were exploring whether to issue their own stablecoins, Poonawala said.
But to gain consumer buy-in, stablecoins must be easy to use, as people are accustomed to simple, instant payment methods like credit cards or using Zelle or Venmo to transfer money quickly.
While stablecoins could eventually disrupt the way daily transactions are handled, it’s unlikely to be an overnight shift. Poonawala likened the process to building the U.S. interstate highway system: “If you’re going to build this out, a lot of infrastructure is needed.”
The Charlotte Economics Club holds monthly luncheons and other events on economic policy, business trends, regional growth issues and global economic themes. The Ledger is the club’s media partner. —Ashley Fahey
Review: ‘Scrooge in Rouge’ stays true to ‘A Christmas Carol’ with a few cheeky twists
Arts critic Lawrence Toppman checked out “Scrooge in Rouge” last week at the Warehouse Performing Arts Center in Cornelius. It’s a show that subverts the yuletide Charles Dickens classic “A Christmas Carol” but somehow stays true to its basic plot and message.
In a review for The Ledger, Toppman wrote:
Christmas isn’t a holiday I associate with resurrection, but that’s what’s going on at Warehouse Performing Arts Center in Cornelius. The facility, beefed up from 55 to 80 seats (including stage-side tables) and smelling of fresh paint on the opening night of “Scrooge in Rouge,” has reawakened this month with the inaugural production by Warehouse Studio Theatre.
The cheerfully cheeky musical offers a series of twists and non-stop jokes — some hoary, some hip — that subvert “A Christmas Carol” yet put Charles Dickens’ basic plot and message across. Three actors and a stalwart pianist leave us groaning and laughing as they vex the halls with bows unholy. Didn’t like that pun? This review and perhaps the show itself aren’t for you.
The show runs through Dec. 20. Read the full review:
➡️ Ledger subscribers can add the free Toppman on the Arts newsletter on their “My Account” page.
You might be interested in these Charlotte events
Events submitted by readers to The Ledger’s events board:
NOW THROUGH DECEMBER 31: “Learning Society Holiday Membership Drive,” Give yourself (or someone you love) the gift of learning this season. Queens University’s Mid-Year Learning Society Memberships are available at all tiers — and for a limited time, you can join for 50% off the regular price. Mid-Year Memberships include all the same benefits as an annual membership, excluding the fall lecture, which has already taken place. Membership is offered at two levels and available as a single or dual membership. Also, the majority of your membership is tax-deductible; you may choose to give the tax-deductible amount through a donor-advised fund. Individual Scholars Circle - $475. Individual President’s Circle - $1,250. Dual Scholars Circle - $950. Dual President’s Circle - $2,500.
SATURDAY: “Kids Night Out: Handmade Holiday Gifts,” 5:30-8:30 p.m., at Arts+ Community Campus, 2304 The Plaza. Come bring your kids for a fun night in while you take a break with a night off! Children will enjoy an evening of play and creation as they make two extra special gifts for family and friends, while parents and caregivers can spend the time holiday shopping. $50.
SUNDAY: “Sing Play Move: Jingle Jam!,” 4-4:45 p.m., at Arts+ Community Campus, 2304 The Plaza. Celebrate the season with music, movement and togetherness! Young children and caregivers will sing familiar seasonal songs, shake and play instruments, explore rhythm through movement and make music together! Activities are best suited for children ages 1-3, and sibling(s) up to age 5 are welcome to join. No more than 5 individuals per family, please. $25.
➡️ List your event on the Ledger events board.
In brief:
Light-rail stabbing gets national attention: After police arrested an undocumented immigrant, Oscar Solarzano, 33, on Friday, alleging he stabbed another man that day on a Lynx Blue Line train, Republican political leaders — including President Donald Trump — have since weighed in on the incident. Solarzano has been charged with multiple misdemeanor and felony counts, including attempted first-degree murder. Interim Charlotte Area Transit System CEO Brent Cagle said in a statement this weekend that “a verbal altercation escalated to the point of a stabbing incident on a Blue Line train.” Charlotte-Mecklenburg Police have said the victim was in critical but stable condition. The incident happened a little more than three months after the fatal stabbing of Ukrainian refugee Iryna Zarutska on the Blue Line, which also gained national attention. (Charlotte Observer)
New police chief sworn in: Estella Patterson, the Charlotte-Mecklenburg Police Department’s first female chief, was sworn in at a ceremony on Friday. “I can say very clearly, and I can see very clearly, that the journey will not be easy, and it will not be quick,” Patterson said at the event. “Nonetheless, I stand committed, I stand resolute, and I’m prepared for such a time as this to wear this badge proudly and to serve this community with distinction.” (Charlotte Observer)
$1.2B in Covid recovery funds set to expire: North Carolina State Auditor Dave Boliek says state agencies have until the end of 2026 to spend the remaining $1.2B in federal Covid funds before they expire. As part of a massive federal stimulus package, the state government received $5.4B in spring 2021. The Office of the State Auditor in a recent report found that by the end of the 2024 fiscal year, less than half of those Covid funds had been dispersed. (WFAE)
Bowl games announced for NC/SC teams: N.C. State will play Memphis in the Gasparilla Bowl on Dec. 19, East Carolina will play Pittsburgh in the Military Bowl on Dec. 27, Clemson will play Penn State in the Pinstripe Bowl on Dec. 27, Coastal Carolina will play Louisiana Tech in the Independence Bowl on Dec. 30, Duke will play Arizona State in the Tony the Tiger Sun Bowl on Dec. 31 and Wake Forest will play Mississippi State in the Duke’s Mayo Bowl in Charlotte on Jan. 2. (CBS Sports)
Charlotte company to sell for $4.8B: Manufacturer ITT said last week it will acquire Charlotte-based SPX Flow for nearly $4.8B. ITT is acquiring the industrial machinery manufacturer from Lone Star Funds, which purchased SPX Flow for $3.8B in 2022. The deal is expected to close by the end of the first quarter. (Charlotte Business Journal)
Pizza tops at CLT airport: The Charlotte airport’s most purchased food item so far in 2025 has been pizza (380,000 slices), and its most popular retail item has been Pure Life water (420,000 bottles), the airport said on social media. Travelers have also bought 179,000 orders of Shake Shack fries, 132,000 pours of Wicked Week Pernicious beer and 40,000 Mt. Olive Pickle Juicers pickle brine. (Charlotte airport on LinkedIn)
West Charlotte football coach out: West Charlotte High football coach Sam Greiner has been removed as head coach and suspended with pay as a teacher pending a Charlotte-Mecklenburg Schools investigation, though CMS has not disclosed the reason for the probe. (The Charlotte Post)
Young childless adults in Charlotte want to relocate: A recent Gensler study found that, more than any other major city except Baltimore, young childless adults in Charlotte are considering moving to another city. About 58% of Charlotte residents surveyed between the ages of 18 and 24 said they were “likely” or “very likely” to leave town. (Axios)
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