Disclaimer: This article is for informational purposes only and does not constitute legal advice.
Detailed Answer
When you negotiate a personal injury settlement in Missouri, unpaid medical bills and liens can significantly affect your net recovery. Understanding how liens work, identifying all outstanding charges and using proven negotiation strategies helps you maximize your award.
What Is a Medical Lien in Missouri?
Missouri’s Uniform Health-Care Liens Act (RSMo § 400.885–400.895) grants certain health-care providers a lien on your tort settlement. To perfect a lien, a provider must:
- File a written notice in the circuit court within 30 days of first treatment.
- Serve the notice on the patient or the patient’s attorney.
If perfected, the lien attaches to proceeds from any judgment or settlement (RSMo § 400.885).
Distinguishing Liens from Outstanding Medical Bills
Not every provider lien is formally perfected. You may still face unpaid bills for:
- Emergency care or hospital stays.
- Specialist visits and diagnostic testing.
- Rehabilitation and therapy services.
Collect all itemized statements, compare charges with Explanation of Benefits (EOBs) and verify medical coding to spot billing errors.
Government and Insurer Subrogation Claims
Medicaid: Under Missouri’s Medicaid subrogation law (RSMo § 208.241), the Department of Social Services may recover from your settlement for care paid by Medicaid.
Medicare: Federal regulations require repayment of conditional payments under 42 CFR 411.37. Obtain a conditional payment letter from Medicare’s Coordination of Benefits Contractor before settlement.
Private Insurers and ERISA Plans: Insurers often assert subrogation or reimbursement under ERISA (29 U.S.C. § 1132). Review plan documents for subrogation language. You can negotiate lump-sum reductions or lien holdbacks.
Strategies to Negotiate Medical Liens and Bills
- Request detailed lien statements and conditional payment letters early in the process.
- Challenge invalid or excessive liens by filing a court motion to exclude or reduce.
- Negotiate payoffs directly with providers—many accept 30–50% of billed charges.
- Hold disputed amounts in escrow while you seek judicial resolution.
- Document all negotiations and agreements in writing to avoid surprises at closing.
Helpful Hints
- Gather all medical bills, EOBs and lien notices as soon as you receive them.
- Keep clear records of correspondence with health-care providers and insurers.
- Obtain itemized billing and check for duplicate or non-covered services.
- Ask your attorney about mediation or settlement conferences to resolve lien disputes.
- Set aside sufficient funds in your client trust account to cover valid liens.