Detailed answer

Quick overview

Texas is a fault-based state for most accident claims. If another person (or their insured) is legally responsible for your injuries, you can seek compensation for past and future medical expenses as part of a settlement or lawsuit. Insurance (the at-fault party’s liability insurer), your own health coverage, or government programs (Medicare/Medicaid) often pay bills first and may later seek repayment from any recovery you obtain.

How medical bills are recovered through a claim

– Liability insurance: After you prove the other party’s fault and the amount of your damages, their liability insurer typically pays medical bills and other damages either by settlement or court judgment. Your medical records and bills support the amount you request for past treatment and the medical testimony supports projected future needs.

– Health insurance and government payors: If your health insurer, Medicare, or Medicaid pays medical expenses initially, those payors usually have subrogation or reimbursement rights. They may ask to be repaid from any settlement or judgment you receive.

Medical providers and liens

Medical providers sometimes try to protect themselves by:

• Placing a lien on your potential recovery under state lien laws.
• Asking for payment up front, negotiating a reduced bill, or placing you on a payment plan if you cannot pay immediately.
• Accepting a “letter of protection” from an attorney, which asks the provider to wait for payment from the client’s settlement.

Texas has statutes and rules that affect hospital and provider liens and third-party reimbursement. You can review Texas statutes and lien rules at the Texas statutes website: https://statutes.capitol.texas.gov/. For general consumer information about insurance claims in Texas, see the Texas Department of Insurance: https://www.tdi.texas.gov/consumer/index.html.

Medicaid / Medicare recovery and Texas third-party liability

If Medicaid or Medicare covers your care, federal and state rules require those programs to try to recover payments from any third-party recovery. Texas explains its Medicaid third-party liability processes here: https://hhs.texas.gov/services/financial/medicaid-third-party-liability. That means you should expect those payors to assert a claim against your settlement and factor that into negotiation decisions.

Timing, settlement choices, and future medical needs

Settlements often resolve all claims (past and future). If you accept a lump-sum settlement without accounting for future medical care, you may be responsible for future bills out-of-pocket. Texas law allows recovery for reasonable and necessary past and future medical expenses, but future expenses often require stronger medical proof or testimony to support the dollar amount requested.

If you can’t pay immediate bills

Options include:

• Using your health insurance (if available) to cover immediate costs.
• Negotiating with providers for reduced charges, payment plans, or charity care if uninsured.
• Asking a treating provider to accept a letter of protection (commonly used when you intend to pursue a claim).
• Filing an insurance claim with the at-fault party’s carrier (this starts their duty to evaluate compensation for medical bills).

How an attorney can help

An attorney who handles accident claims can:

• Collect and organize medical records and bills to prove damages.
• Negotiate with liability insurers so offers account for future care.
• Resolve or reduce subrogation claims from health insurers and Medicaid/Medicare.
• Arrange letters of protection or negotiate directly with providers to avoid immediate collection while your claim proceeds.

Hypothetical example

Hypothetical: You are injured in a rear-end collision in Texas and have $25,000 in ER and follow-up bills. The other driver’s insurer offers $15,000 early. You still need future physical therapy and possible surgery totaling an estimated $30,000. If you accept $15,000 now without preserving future claims, you risk paying the remaining care yourself. With an attorney’s help you could document future medical needs, negotiate a higher settlement to cover projected costs, and address any health insurer subrogation before accepting an agreement.

Key takeaways

• Your claim can cover medical bills if the other party is at fault and you can prove the expenses are reasonable and related to the accident.
• Health insurers and government payors often have rights to repayment from your recovery; plan for this when negotiating a settlement.
• Do not sign a full release or accept a final payout until you understand future medical needs and any subrogation claims.

For general guidance on insurance claims in Texas, see the Texas Department of Insurance: https://www.tdi.texas.gov/consumer/index.html.

Helpful hints

• Seek medical care immediately and keep detailed records: dates, diagnoses, bills, and provider notes.
• Report the accident to the at-fault party’s insurer quickly and keep a claim number and adjuster contact information.
• Keep copies of all medical bills and health-insurer explanation-of-benefits (EOB) statements—these show who paid and what may be subject to reimbursement.
• Ask providers about payment plans, discounts, or charity care if bills are unaffordable.
• If a provider asks you to sign a lien or bill-protection agreement, read it carefully and consider consulting an attorney first.
• Before accepting any settlement that closes your case, get a realistic estimate of future medical costs.
• If Medicare or Medicaid paid for care, notify the program promptly and expect a claim for reimbursement; factor that into settlement negotiations.
• Contact an attorney experienced with Texas accident claims before settling to protect your rights and reduce the risk of unexpected personal liability for future bills.

Disclaimer: This information is educational only and does not constitute legal advice. Laws and procedures vary by case and change over time. Consult a licensed attorney in Texas for advice about your specific situation.

Additional resources:

• Texas statutes and codes: https://statutes.capitol.texas.gov/
• Texas Department of Insurance (consumer information): https://www.tdi.texas.gov/consumer/index.html
• Texas Health and Human Services — Medicaid third-party liability: https://hhs.texas.gov/services/financial/medicaid-third-party-liability