Detailed Answer

What is a medical lien?

A medical lien is a claim by a medical provider, hospital, or health insurer to be paid from the money you recover in a personal injury settlement or judgment. Liens arise in several ways: by contract (for example, a hospital agreement), by statutory or regulatory right, or by subrogation (an insurer seeking reimbursement). In New Hampshire, these claims are resolved under state law principles and relevant federal rules (for Medicare and Medicaid).

Who can assert a lien?

• Hospitals and treating medical providers
• Private health insurers or ERISA plan administrators seeking reimbursement
• Medicare and Medicaid (state Medicaid agency may assert recovery rights)

Step-by-step process to verify and clear medical liens

1. Identify potential lien holders.

   Start by collecting all medical bills, provider names, and any letters or statements you received. Your attorney or claims administrator should request lien statements from the treating providers, hospitals, and health plans.

2. Request itemized bills and legal basis for each claim.

   Ask each claimant for an itemized ledger showing dates of service, billed amounts, payments received, adjustments, and the legal basis for the claim (contractual lien, subrogation, statutory claim). Insist on written documentation; vague or unsupported demands are easier to challenge.

3. Check for priority and coordination issues.

   Some liens have higher priority (for example, state Medicaid recovery). Federal programs such as Medicare have mandatory recovery rules under federal law. New Hampshire’s state Medicaid agency enforces its right to be reimbursed for conditional medical assistance it paid; see New Hampshire Department of Health and Human Services for state procedures: https://www.dhhs.nh.gov/.

4. Verify amounts and look for reductions.

   Medical bills often include write-offs, billing errors, or negotiated rates with insurers. Providers commonly accept less than billed amounts. You or your attorney should negotiate reductions and ask for a final payoff statement. Keep records of payments, liens, and correspondence.

5. Address federal-payor claims (Medicare/Medicaid) early.

   If Medicare may have paid for treatment, you must notify Medicare and obtain a conditional payment amount so you can resolve Medicare’s claim before you finalize the settlement. For general Medicare recovery information, see the CMS Recovery page: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Recovery. For Medicaid, the New Hampshire DHHS handles state recovery actions.

6. Allocate settlement proceeds and consider a holdback/escrow.

   Common practice: the settlement agreement specifies how much of the gross settlement will go to pay liens, attorneys’ fees, and costs. If lien amounts remain in dispute, parties often set aside funds in escrow (a holdback) until the dispute resolves. This protects the plaintiff from future claims while allowing the primary settlement to close.

7. Obtain releases and lien releases.

   Once liens are paid or resolved, obtain written lien releases or satisfaction documents from each claimant. Keep these for your records. If a lien remains unresolved, get a written acknowledgment describing the dispute and the planned holdback amount.

8. Close the settlement and distribute funds appropriately.

   After liens are resolved or money is placed in escrow, finalize settlement paperwork. Make sure the settlement agreement clearly states how liens were handled and who is responsible for any remaining claims.

9. Address lingering claims.

   If a claimant later pursues additional money, rely on releases, escrow records, and your settlement documentation. If litigation becomes necessary, your attorney can defend using these documents and by arguing reductions or invalidity of the asserted lien.

Typical timeline — how long will verification and clearance take?

Timelines vary by the type of lien, the responsiveness of claimants, and whether federal programs are involved. Use these general benchmarks:

• Identification and initial documentation request: 1–4 weeks.
• Provider payoff statements and basic verification: 2–8 weeks (often faster if providers cooperate).
• Negotiation with providers and insurers: 2–12 weeks depending on complexity and willingness to reduce).
• Medicare conditional payment review and final demand: often 3–12 months. (Medicare requires a final accounting for conditional payments and can take months unless you use a qualified lawyer or a Section 111/MARS process to speed review.) See CMS Recovery: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Recovery.
• Medicaid/state recovery: timing depends on the state agency; plan for weeks to months — consult New Hampshire DHHS: https://www.dhhs.nh.gov/.
• If disputes lead to litigation over a lien, resolution may take several months to years.

Common complications that add time

• Unresponsive providers or insurers
• Large or unclear itemized bills that require audit
• Medicare or Medicaid claims that need federal/state review
• Disputes about allocation between medical damages and other damages
• Complex ERISA plan subrogation claims requiring plan administrator review

New Hampshire-specific notes

New Hampshire follows state civil procedure and contract rules when enforcing or defeating liens. Many lien disputes are resolved by negotiation, not by special statutory mechanics. For state statutes and general statutory text, you can review the New Hampshire Revised Statutes at the General Court website: https://www.gencourt.state.nh.us/rsa/html/. For issues involving state Medicaid recovery, consult the New Hampshire Department of Health and Human Services: https://www.dhhs.nh.gov/.

When should you involve an attorney?

Hire an attorney as soon as possible if:

• You face multiple or large lien claims
• Medicare or Medicaid recovery is involved
• Claimants refuse to provide itemized statements or demand full billed amounts
• You need escrow language or protection in the settlement agreement

An attorney experienced in personal injury settlement and lien resolution can often speed verification, negotiate reductions, draft holdback language, and protect your net recovery.

What documents to collect and keep

• All medical bills and itemized statements
• Proof of payments received (insurance or out-of-pocket)
• Written demands or lien statements from providers or insurers
• Correspondence with Medicare or Medicaid (conditional payment letters)
• Settlement agreement and escrow/holdback paperwork
• Written lien releases or satisfaction letters

Helpful Hints

• Start early: request payoff statements from every provider and insurer as soon as liability or settlement becomes likely.
• Ask providers for itemized, date-specific statements showing adjustments and payments — not just a one-line demand.
• Don’t assume billed charges equal the amount you must pay; negotiate reductions and use evidence of usual-and-customary or Medicare rates when appropriate.
• If Medicare might be involved, request a conditional payment amount from CMS immediately; resolving Medicare’s claim late can delay closing for months.
• Use escrow or a holdback in your settlement to cover disputed liens rather than letting disputes block the entire settlement.
• Get lien releases in writing before distributing funds to avoid future reclaims.
• Keep careful records — they are your best protection against late claims.
• Consult an attorney if you encounter noncooperative lienholders, unclear subrogation demands, or federal payors.