Short answer: You generally must identify and verify the lien, present proof and a settlement allocation to the medical provider (and any public-payor like MassHealth or Medicare), attempt negotiation or mediation, obtain a signed release or lien waiver, and if the provider refuses, ask the court to resolve competing claims to the settlement funds. The exact steps depend on whether the lien is statutory, contractual, or a government subrogation claim (MassHealth/Medicare).

Detailed answer — step‑by‑step process

1. Identify the type and basis of the lien

Start by collecting all notices and written statements from medical providers, hospitals, health insurers, or government payors. A “medical lien” may come from:

• a provider asserting a lien under state law or hospital lien rules;
• a provider who received an assignment of your claims;
• a private insurer with a contractual right of subrogation; or
• a government program (MassHealth or Medicare) asserting repayment/subrogation).

Knowing the source matters because statutory liens and government subrogation follow different rules and timelines.

2. Demand full documentation and an itemized bill

Ask the lienholder for:

• an itemized statement of services and charges;
• the legal basis for the lien (statute, assignment, or contract);
• copies of any written lien filing or notice they gave to you or the insurer; and
• any assignment or intake forms you signed that might have created the obligation.

Confirm whether the bill reflects gross charges or an adjusted (insurance-negotiated) rate. Providers sometimes demand full charges even though typical recoverable amounts are lower once insurance contracts and reasonable‑value rules apply.

3. Check government payor rules early (MassHealth, Medicare)

If MassHealth or Medicare paid for your care, those programs can assert statutory recovery or a right to reimbursement from your settlement. MassHealth has explicit recovery/subrogation authority (see Massachusetts General Laws, Chapter 118E). Learn the program’s procedures and timelines so you do not inadvertently disburse funds before satisfying their claim.

MassHealth resources and program rules: M.G.L. c. 118E and MassHealth information: MassHealth (mass.gov). For Medicare, review federal Medicare Secondary Payer rules and the Medicare Coordination of Benefits & Recovery site: CMS — MSP and recovery.

4. Determine what is “reasonable” and prepare your arguments

Common bases to seek a reduction include:

• the provider’s billed charges exceed amounts customarily accepted from insurers;
• the provider’s services were partially unrelated to the injury;
• you already resolved certain charges through insurance payments; or
• the settlement amount and recovery net to the plaintiff would be unfair if the lien remains at full billed amount.

Assemble supporting evidence: medical records, proof of insurance payments, explanation of benefits, customary rate schedules, and any communications showing a provider’s write‑offs.

5. Negotiate or mediate with the lienholder

Most reductions happen at the negotiation stage. Common approaches:

• Ask the provider to accept its usual contracted/Medicaid/Medicare rate rather than gross billed charges.
• Propose a percentage split tied to net recovery after attorney fees and costs (for example, pro rata on the net recovery or a fixed dollar compromise).
• Offer an immediate partial payment in exchange for a full release of the lien.

Get any agreement in writing and obtain a signed lien release or satisfaction document that names the case and identifies the exact amount to be released.

6. If negotiation fails, use a court procedure to resolve competing claims

If the provider refuses to reduce and you cannot reach an agreement, you can ask the court to determine lien priority and the amount to be paid. Common judicial routes include:

• filing a motion in the pending personal injury action asking the court to approve the settlement and order distribution of the settlement funds (often with notice to lienholders);
• interpleader—if a third party (often an insurer or defendant) holds settlement funds, the stakeholder can deposit funds with the court and ask the court to resolve claims to those funds; and
• an independent action in equity or declaratory judgment to determine lien validity.

Where the plaintiff is a minor or legally incapacitated person, the probate court must often approve any settlement and distribution. See the Massachusetts Probate and Family Court for required filings and guardian ad litem procedures: Massachusetts Probate and Family Court.

7. Protect the settlement: written releases and distribution orders

Once you obtain an agreement or a court order, secure:

• a signed lien release or satisfaction from the provider;
• a written confirmation from MassHealth or Medicare about the amount they will accept (or a plan for a conditional payment); and
• a court order, if applicable, directing the disbursement of proceeds and protecting the settling party from later claims.

Do not distribute settlement funds until you have releases or clear court direction. Disbursing funds prematurely can expose you to new claims and personal liability.

8. Keep clear records and comply with timelines

Keep copies of all correspondence, itemized bills, EOBs, releases, and court filings. Government payors often have strict time limits to assert claims or accept settlement offers; missing a timeline can complicate the process or trigger penalties.

When you should involve an attorney

Consider hiring a Massachusetts personal injury attorney when:

• multiple providers and payors assert liens;
• MassHealth or Medicare seeks reimbursement;
• the lienholder refuses to negotiate and you may need a court ruling; or
• you are unsure how to allocate settlement funds between medical bills, attorney fees, and your net recovery.

An attorney with experience in lien resolution can prepare the paperwork, request the right information, negotiate reductions, and, if needed, file motions or interpleader actions.

Key Massachusetts resources

• Massachusetts General Laws — General Laws index: https://malegislature.gov/Laws/GeneralLaws
• MassHealth (program and recovery/subrogation resources): https://www.mass.gov/orgs/masshealth
• Massachusetts Probate and Family Court (required approvals for minors/incapacitated persons): https://www.mass.gov/orgs/probate-and-family-court
• Medicare Secondary Payer and recovery (federal rules): https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery

Helpful Hints

• Request an itemized bill and EOBs early—billing details often resolve disputes.
• Ask for a written lien release before you sign the final settlement disbursement.
• Offer a prompt partial payment in exchange for a full release; cash now can buy a meaningful reduction.
• Remember that MassHealth and Medicare have independent recovery rights—settlement checks can be frozen if you don’t sort these out first.
• If a provider claims full billed charges, compare with insurer-negotiated rates and cite those when negotiating.
• If you must ask the court to decide, give clear notice to all lienholders so the judge can resolve competing claims fairly.
• Keep all agreements in writing; oral promises are hard to enforce.