We gave treatment to a car accident Patient & Patient's Attorney is paying only 20% of our total bill as final payment. This amount doesn't cover our total expenses for this Patient at all. Patient signed a medical lien prior to the treatment. Attorney is saying that they settled this Patient's case for less money. From that settlement, attorney took good portion $ as their fee. What can I do to get paid decent? How can I find out what is the total settlement amount Patient received?

What I meant by"Medical lien" - It is a form signed by Patient and/or their attorney saying Patient is authorizing insurance company and/or their attorney to pay directly to the provider, Patient is responsible for payment and agree that the fee for the services are not contingent on what an insurance company may choose to pay.

Look at the terms of this "medical lien". Something doesn't sound right here. Generally a medical lien is filed against a settlement when the patient doesn't pay. That he signed something "prior" to treatment makes me wonder. The only reason I can see this is if you were agreeing to accept a share of the settlement as payment. If that's the case, then you may be stuck.

However if no such agreement was made, then it doesn't matter what the settlement was. You are entitled to pay for your services. If the patient's attorney settled for less then his costs, then he was at fault.

You will, however, have to sue the patient for what he owes.

What I meant by"Medical lien" - It is a form signed by Patient and/or their attorney saying Patient is authorizing insurance company and/or their attorney to pay directly to the provider, Patient is responsible for payment and agree that the fee for the services are not contingent on what an insurance company may choose to pay.

Thank you

You do the same thing as you would any patient that does not pay all of their bill, you bill them and sue them.

It does not matter if the patient was stupid enough to settle for less than their medical bills.

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Originally Posted by rehab

What I ment by"Medical lien" - It is a form signed by Patient and/or their attorney saying Patient is authorizing insurance company and/or their attorney to pay directly to the provider, Patient is responsible for payment and agree that the fee for the services are not contingent on what an insurance company may choose to pay.

Thank you

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Ok, that's not a medical lien as I understand it. A lien is an encumbrance attached to something (property, future settlement) that has to be settled before the property can be transferred. What you are referring to is standard for healthcare providers. It an assignment of benefits, authorizing an insurer to pay the provider directly.

This means you should be filing a claim with the patient's health insurance provider. The provider would then pay you their covered benefit. If the cost of care is not completely covered then you need to get the balance from the patient.

But, again, whatever their settlement with the insurance company over the accident was, has no bearing on you. You provided a service and are entitled to payment for that service. If the patient or his attorney pulls the settlement line on you, just tell them that has nothing to do with you.

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Originally Posted by rehab

We gave treatment to a car accident Patient & Patient's Attorney is paying only 20% of our total bill as final payment. This amount doesn't cover our total expenses for this Patient at all. Patient signed a medical lien prior to the treatment. Attorney is saying that they settled this Patient's case for less money. From that settlement, attorney took good portion $ as their fee. What can I do to get paid decent? How can I find out what is the total settlement amount Patient received?

What I ment by"Medical lien" - It is a form signed by Patient and/or their attorney saying Patient is authorizing insurance company and/or their attorney to pay directly to the provider, Patient is responsible for payment and agree that the fee for the services are not contingent on what an insurance company may choose to pay.

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First off, don't cash the check and send it back to the attorneys saying that you do not agree to accept that amount.

What you are dealing with is extremely common:

Patient involved in an accident and has no health insurance or manner in which to pay for medical treatment. You have the patient sign a lien letter stating that you will wait to accept payment from the proceeds of the settlement. The patient's attorney SHOULD have his file marked accordingly, and take the lien into consideration prior to settling the case. Now, as a medical provider, it is customary for you to give a 33% discount of the total bill in exchange for two things (1) the patients attorney is basically acting as a collection agent for you; and (2) if the patient had insurance, the insurance company would be paying you a fraction of your bill as well.

Here is where it gets sticky. The plaintiff's attorney should not have settled the case without satisfying your lien. This is something completely unethical assuming that they did not have the Plaintiff sign an acknowledgement. Basically, they are taking their fee, but leaving the Plaintiff exposed to personal liability for the unpaid protion of the bill.

If I were you, I would start by speaking with the patient's attorney about the forgoing. Follow up with a letter (copying the patient) explaining your belief that it is improper, and perhaps unethical to enter into a settlement agreement that does not provide for satisfaction of mediacl liens as they are taking their own legal fee at the expense of exposing their client to personal liability for the debt.

Speak to the patient and explain this to them. Try to figure out what court the case was venued in and what the disposition was. If the case was settled in open court, there will be a statement on the record by the plaintiff's attorney as to any liens that exist.

As a practical matter, assuming you were charging the patient more then you would receive from an insurance company, it would probably be in your best interest to accept half.

I may have missed that you may have already gotten a check. If you have definitely do not cash it and send it back.

I see side is agreeing with me that accepting a settlement that doesn't cover all the actual bills seems unethical.

The only thing I don't quite agree with is the fee cut. If the patient had health insurance that you were afffiliated with, yes you would probably take a pct of your fee. But if you were expecting to be paid from the settlement then you could expect Reasonable and Customary charges.

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Originally Posted by ScottGem

The only thing I don't quite agree with is the fee cut. If the patient had health insurance that you were afffiliated with, yes you would probably take a pct of your fee. But if you were expecting to be paid from the settlement then you could expect Reasonable and Customary charges.

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The fee cut of 33% is the custom and practice of everyone in the industry. The doctors don't mind because (a) it saves them the trouble of collecting what would otherwise be a tough debt to collect (how many people do you know with no health insurance that are rolling in assets?); and (b) 66% of what they charge patients is usually more than what insurance companies pay for the same services, so they are often still making out on the deal.

Something to realize about th economics of minor lawsuits. As an attorney, if I have a lawsuit that can be settled for $10,000, yet there is $5,000 medical lien, we have a big problem if the provider won't reduce the lien. Here is why. In the above scenario the payouts would be as follows:

Assume $1,000 in fee and expenses reimbursed to the attorney off the top.

1/3 of the remaining $9,000 to the attorney = $3,000

$5,000 of the remaining $6,000 goes to the doctor's office

Leaving the Plaintiff with $1,000 out of a $10,000 settlement.

You know what happens in cases like this? We go to trial.

It is elementary that the Plaintiff must agree to any settlement. The Plaintiff is never going to agree to a settlement where he sees $1,000 out of $10,000. So even if the $10,000 is the best result for the Plaintiff, and he has very little chance of prevailing at trial, the case is nonetheless tried because the Plaintiff has nothing to lose.

But who DOES have something to lose? THE DOCTOR. What is a medical lien worth on a defense verdict? $000.00 So by refusing to negotiate a reduction in the lien amount, the doctors office is essentially increasing its chances of getting nothing.