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Detailed answer: step-by-step process under Washington law

1) Identify all potential lienholders

Before you settle, compile a list of everyone who might claim repayment from your recovery. Common lienholders include:

• Hospitals and treating physicians
• Ambulance companies and urgent care clinics
• Private health insurers (including ERISA plans)
• Medicare (if you are a beneficiary)
• Washington Apple Health/Medicaid (state recovery/subrogation)
• Workers’ compensation or no-fault insurers (if applicable)

2) Request written, itemized payoff statements

Ask each potential lienholder for a written demand or payoff statement that shows:

• Specific services billed (dates, CPT / description)
• Charges, payments applied, and the claimed balance
• Legal basis for the lien or subrogation claim
• Name and contact info for the person authorized to negotiate and issue a release

Having itemized documentation lets you verify accuracy and spot any duplicate or incorrect charges.

3) Check validity and priority of each claim

Not every bill becomes a valid lien. Review whether the claim meets Washington law and notice requirements. For publicly funded benefits (Washington Apple Health/Medicaid), the state has recovery and subrogation authority; see Washington’s medical assistance statutes for program rules: RCW chapter 74.09 (medical assistance). For Medicare, the federal Medicare Secondary Payer rules may create a repayment obligation for conditional payments; see CMS guidance: CMS — Coordination of Benefits and Recovery.

4) Verify amounts and seek reductions

Most providers will accept a reduction from gross billed charges if the settlement does not cover full billed amounts. Typical steps:

• Compare billed charges to usual and customary or contracted rates.
• Ask for full lien documentation and the legal citation under which they assert a lien or right to repayment.
• Negotiate reductions in writing. Providers often settle for a negotiated payoff (sometimes a fraction of billed charges).

5) Resolve Medicare and Medicaid claims before distribution

Medicare may issue a conditional payment demand. You or your attorney should request a conditional payment amount from Medicare, then either resolve the claim or set aside funds. Washington Apple Health (Medicaid) looks to recover from third-party recoveries under state law; see the state chapter referenced above and contact the Washington Health Care Authority’s third-party liability program for payoff instructions: WA Health Care Authority — Third-Party Liability.

6) Use an escrow or neutral closing agent

Do not distribute settlement funds until lien issues are resolved. Place proceeds in escrow and direct the escrow agent to hold distribution pending payoff or receipt of written releases and satisfactions. A settlement demand package should list known lienholders and include instructions for final payoffs.

7) Obtain written releases and satisfactions

After a lienholder accepts payment, require a signed release or satisfaction of lien that names you and your case, and states the lien is fully released. For public programs, get formal written confirmation of the payoff amount and release (or an agreed offset). Keep these documents in your permanent file.

8) Document final accounting and distribute remaining proceeds

Prepare a final settlement accounting that shows gross recovery, attorney fees, costs, amounts paid to lienholders (with copies of payoffs/releases), and net to you. Make sure the release language in your settlement broadly bars future claims by any provider that should have been listed.

Timeframe: how long will it take?

Timelines vary by lien type and complexity. Typical ranges:

• Private providers (hospital, clinic, ambulance): 2–8 weeks to get statements and negotiate payoffs if straightforward.
• Private insurer subrogation (including ERISA plans): 4–12 weeks, sometimes longer if documentation and plan rules are complex.
• Medicare conditional payment process: often 60–180 days depending on the backlog, documentation, and whether a demand is contested. See Medicare guidance for current processing times: CMS — Coordination of Benefits and Recovery.
• Washington Apple Health/Medicaid: allow several weeks to a few months depending on the agency workload and whether the state issues a claim or negotiates.

Complex cases (multiple lienholders, unclear responsibility, ERISA plans, or disputes about liability) can take many months. Planning on 30–90 days for ordinary cases and 3–6+ months for cases involving federal or state program recovery is prudent.

When you should hire an attorney

If liens are numerous, large, or involve Medicare or state Medicaid subrogation, consider hiring a Washington personal injury attorney who handles lien negotiation and escrowing settlement funds. An attorney experienced with subrogation and federal/state repayment rules can often reduce total payoffs and speed release of funds.

Relevant Washington resources

• Washington Revised Code of Washington, chapter on medical assistance (general rules): https://app.leg.wa.gov/rcw/default.aspx?cite=74.09
• Washington Health Care Authority — Third-Party Liability and subrogation information: https://www.hca.wa.gov/billers-providers/program-administration/third-party-liability
• Federal Medicare recovery rules and conditional payment info: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview

Helpful Hints

• Get written payoff figures. Never rely on oral statements.
• Ask each provider to identify the legal basis for its claim and the precise account number and patient name used.
• Request itemized bills that match the dates of service in your claim file.
• Put settlement funds in escrow until you have signed releases from all known lienholders.
• For Medicare beneficiaries, request a conditional payment letter early and follow the CMS demand process to avoid unexpected later demands.
• Contact the Washington Health Care Authority early if Washington Apple Health may assert a recovery claim.
• If a private insurer’s claim involves an ERISA plan, know that federal rules may govern recovery and that negotiation can be technical—consider counsel who knows ERISA.
• Keep a strict paper trail: letters, emails, payoff statements, canceled checks, and signed releases. These protect you from future claims.
• Consider a lawyer if payoff negotiations or interagency coordination stall—an attorney can often obtain faster, reduced payoffs and safeguard your net recovery.