A major car crash in Texas can result in more than just physical pain. Within days, the first of the medical bills begins rolling in. Emergency room visits. Hospitalizations. Tests. Specialists. Follow-ups. In short order, the number of medical statements begins to add up quickly, far exceeding the income level for the majority of people.
What the average person does not understand is that medical bills do not have to be paid as billed. Attorneys specializing in personal injury settle medical bills on a regular basis. And while the savings may not always be dramatic, the difference can certainly be substantial. For nearly 29 years now, attorneys with Jay Murray Personal Injury Lawyers have been fighting for clients throughout the Dallas area to secure not only fair financial compensation for injuries sustained due to someone else’s negligence, but also to protect as large a share of those dollars as possible.
Below, we will walk you step-by-step through the process of settling medical bills, what the laws regarding medical billing in Texas are, and what type of discounts you can reasonably anticipate when attempting to reduce medical bills.
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(214) 855-1420Why Are Medical Bills Typically So High Following a Car Crash?
Have you ever seen a hospital statement and wondered, “That can’t possibly be correct?” More likely than not, you were right. 
When hospitals provide treatment to individuals without negotiated contracts in place between them and that individual’s health insurance carrier, they charge what is commonly referred to as a “chargemaster rate.” These chargemaster rates are typically 2-5 times higher than what a hospital would accept from a third-party payer, such as a health insurance company, for providing the exact same service. Therefore, if you were involved in an auto collision and required emergency medical attention as a self-pay patient, those high chargemaster rates are likely going to show up on your medical bills.
Common examples of costs incurred due to a severe automobile Accident include emergency room facility fees (which are in addition to physicians’ fees), diagnostic testing, including CT scans and MRIs; surgical procedures and anesthesia; specialist consultation; and additional follow-up care, including physical therapy.
Adding yet another layer of complexity to the issue is the fact that many healthcare providers agree to wait to receive payment for services rendered until the client’s personal injury case is settled. While this may appear beneficial to consumers, unfortunately, healthcare providers usually submit a lien against the client’s potential future recovery based upon the full, non-reduced amount of the services provided. Without intervention by either the consumer or an attorney representing them, a very substantial portion of the potential recovery in their personal injury lawsuit could potentially be lost prior to the consumer receiving it.
Texas Statutes Regulating Discounts on Medical Bills
Texas has enacted several statutes that govern how medical liens function within injury litigation in Texas. By understanding these statutes, you understand why retaining an attorney is critical to maximizing recoverable damages from the responsible party.
The Texas Hospital Lien Act (Texas Property Code §55)
While the Texas statute permits hospitals to place liens upon emergency care rendered to a patient for non-payment purposes, the statute imposes specific obligations upon hospitals, including requiring strict compliance with notice provisions. Furthermore, a hospital can only assert charges for care that are deemed “reasonable and necessary.” This language is particularly relevant since hospital charges are generally not “necessary” nor are they “reasonable.”
Jay Murray Law contests excessive liens based upon an assertion that the asserted amounts do not fairly reflect the reasonable cost of providing those services. Frequently, merely challenging the reasonableness of the lien causes a substantial reduction in the lien amount.
Balance Billing Protections in Texas and the No Surprises Act
Both Texas law and the federal No Surprises Act prohibit out-of-network providers from charging patients for emergency services or other specified circumstances where the patient had no ability to select an out-of-network provider. If you received medical treatment from an out-of-network provider whom you did not choose, such as an anesthesiologist who practices outside your network at an in-network hospital, there may exist a viable legal basis for contesting the fee. There exists a Texas Department of Insurance Mediation Process specifically designed to handle balance billing disputes.
Federal Liens – Medicare, Medicaid, VA, and ERISA
If your medical treatment was funded either wholly or partially by Medicare, Medicaid, Veterans Administration, or an Employer Group Health Plan governed by ERISA, then federal law governs repayment procedures related to those programs. Each of these entities utilizes statutory formulae to determine maximum allowable repayments from injured victims’ recoveries. Experienced attorneys representing injured parties understand these formulas and may be able to negotiate a waiver in instances where an injured party faces undue financial hardships.
Typical Reduction Ranges
Each case is different; however, the following provides an example of what can be achieved:
| Situation | Typical Reduction Range | Example |
| Hospital lien (Texas) | 30–50% | $80,000 lien reduced to $40,000–$55,000 |
| Health-insurance subrogation claim | 25–40% | $50,000 reimbursement claim reduced to $30,000–$37,500 |
| Uninsured or underinsured accident victim | 40–60% | $75,000 bill reduced to $30,000–$45,000 |
| Medicare/Medicaid lien | 10–30% | Federal formulas apply, but hardship compromises are sometimes possible |
Again, these are ranges. What you receive as a settlement award is contingent upon the extent of your injuries, the existence of any applicable insurance coverage, and the identity of the medical providers involved in your care. However, these figures reflect realistic settlements that occur frequently in Texas personal injury cases.
How Lawyers in Texas Reduce Medical Bills
Auditing and Review of Bills
First, we ask for itemized bills. Not the summary statement that states “hospital services – $82,000,” we need the breakdown on line items as stated in the form of HCFA-1500 & UB-04. Next, we review those line items compared to your actual medical records. Billing errors occur more frequently than most people realize. Duplicate billing for the same service, up-coding (charging for a higher-priced procedure than what occurred), unbundled billing (breaking apart a single procedure into multiple billing entries), and charges for services that have no supporting notes in the medical record are commonly found. Once these errors are located, this commonly reduces billed charges immediately prior to any negotiations.
Negotiation Strategies
After reviewing the bills, we then send formal requests for reductions to all lien-holders and providers. This is not a casual conversation; we reference specific Texas statutes and case law that support lower billing charges, and document why we believe the requested billing charge(s) are unreasonable.
One of the negotiation tools we utilize is the Letter of Protection. This is a written agreement to pay a healthcare provider for services rendered for your treatment. It allows clients to obtain necessary treatment without making advance payments to the provider, and provides us with additional bargaining power when negotiating, since the provider is assured of receiving payment upon conclusion of your case.
We also rely upon legal doctrine that can greatly impact the recovery amounts allowed by health insurers and other lien-holders. The two primary examples of such doctrine are the Common Fund Doctrine and the Made Whole Doctrine. Under the Made Whole Doctrine, a health insurer generally cannot recover any portion of its subrogation claim if recovering the claim would prevent you from being made whole for your damages. Both of these examples are effective arguments when settlement funds are limited.
Other negotiation tools include prompt payment or lump sum offers (many times, providers will accept a reduced rate for prompt and guaranteed payment), pro-rated payment agreements where settlement funds do not cover all medical expenses, and using the leverage of an experienced attorney who has successfully taken cases to trial.
Medicare, Medicaid, and ERISA plans have much more restrictive methods of negotiation due to federal law governing reimbursement methods and formulas; however, even within those constraints, many times there is still opportunity for negotiation and/or obtaining a waiver in instances of financial hardship.
Subrogation and Liens
Subrogation is defined as the right of your health insurer or governmental agency to recover reimbursement from your settlement award after they have paid for your medical treatment. While it seems logical that they should recover what they paid for your medical treatment, in practice, subrogation claims can consume a significant portion of what you actually receive.
We validate the legitimacy of each lien. Not all liens are valid. Some liens may not meet statutory notice requirements. Some liens may include charges unrelated to your accident. Some liens may be grossly exaggerated. We challenge improper or excessive subrogation claims as part of our representation.
Examples of lien claims commonly encountered in Texas personal injury cases include: (I) hospital liens pursuant to the Texas Hospital Lien Act; (II) physician/clinic liens; (III) health insurance subrogation claims; (IV) Medicare/Medicaid liens; and (V) VA liens. Each type has varying statutory provisions governing lien imposition, collection, and enforcement, requiring unique approaches by attorneys.
Timing and Length of Settlement Negotiations
Many people assume that once a settlement is achieved, their money will arrive shortly thereafter. Unfortunately, before disbursement occurs, negotiations with remaining medical creditors/liens must occur. The length of time for this process varies depending on the number of creditors/liens involved.
To provide perspective regarding what you should anticipate after reaching a settlement:
Obtaining all medical records and bills can take 1-2 weeks. Auditing bills, validating lien entitlements, and developing negotiation strategies can take another 2-4 weeks. Actual negotiations with creditors/providers generally last 2-8 weeks, although longer timelines may exist when multiple creditors/providers are involved or where one creditor/provider is slow to respond.
As previously mentioned, we begin negotiations with creditors/providers early in the process when large liens threaten to undermine the overall settlement amount.
Patience is key during this process. Pressuring for a resolution can result in leaving substantial money on the table. Creditors/lienholders are more likely to be willing to settle their claims at a discounted amount (i.e., a meaningful reduction) in order to resolve their interest in the matter sooner rather than later.
Factors Impacting the Degree of Reductions Available for Your Medical Expenses
No two cases are identical. Thus, numerous factors determine the degree of reductions available for your medical expenses.
The maximum amount available for reduction is determined by the total dollar amount of your settlement and/or the at-fault party’s policy limits. There are various factors influencing the level of reduction achievable per bill:
- The larger your settlement dollars relative to your medical bills, the greater ability you have to negotiate meaningful reductions in your medical expenses.
- The nature and complexity of your injuries influence how much treatment you needed and how defensible those treatment charges were.
- Where your treatment occurred (in-network vs. out-of-network) influences what rate structures are utilized.
- The type of insurance coverage you have determines which laws apply.
- Finally, whether your medical bills contained errors is often the largest factor impacting your potential for achieving meaningful reductions in your medical expenses. Errors provide attorneys with leverage.
Additionally, an experienced attorney plays a critical role in reducing medical bills. An attorney who understands which arguments work best with which providers, which statutes provide a basis for arguing, and when to be aggressive vs. compromising based on knowledge gained through years of experience is essential to maximizing potential reductions.
Examples of Reducing Medical Expenses from Real Cases at Jay Murray Law
Example Case #1: Reduced Hospital Lien by 45%
A client contacted us after suffering serious injuries resulting from a motor vehicle collision in Dallas County. Following transport by ambulance to a trauma center and subsequent hospitalization for approximately five days, the trauma center filed a hospital lien for $94,000. After conducting an audit of the itemized bill and establishing numerous discrepancies between the itemized bill and her medical records, after citing the Texas Hospital Lien Act’s Reasonable & Necessary Standard for Hospital Charges, we successfully negotiated with the hospital to reduce the lien amount to $51,700, representing a reduction of approximately $42,000 from the original lien amount filed by the trauma center. The client retained this reduced amount.
Example Case #2: Reduced Subrogation Claim
Another client was involved in a truck collision and received medical care through his employer’s group health plan, which paid approximately $67,000 towards his medical expenses. Upon settlement completion, the health insurer demanded repayment of the full subrogation amount ($67,000). Utilizing the Made Whole Doctrine, we provided extensive documentation illustrating that the client’s settlement did not adequately compensate him for his damages. As a result, the insurer reduced the subrogation demand to $39,000, allowing the client to retain substantially more dollars.
While neither Example Case #1 nor Example Case #2 reflects typical outcomes in every instance, nor does prior success guarantee similar results, these cases illustrate the types of efforts made on behalf of Clients after settlement has been reached.
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Can You Negotiate Medical Bills Without an Attorney?
Yes, technically, anyone can attempt to negotiate a reduction in their medical bills by calling the billing department of their healthcare provider(s) and requesting a reduction.
While occasionally successful (especially when dealing with smaller healthcare providers), there is a substantial difference between what an individual can accomplish and what an experienced attorney can accomplish.
Healthcare providers know that an uninsured/unrepresented individual lacks knowledge of applicable statutes/laws and lacks leverage in negotiations. When an attorney, preferably one with prior experience, sends a formal request demanding a reduction citing Texas Property Code Section 55, along with documentation supporting said demand, responses differ dramatically from those received by unrepresented individuals.
If you are experiencing excessive medical debt unrelated to a personal injury lawsuit, there are alternative avenues available to assist you. The Texas Department of Insurance operates a mediation program addressing billing disputes involving out-of-network healthcare providers. Additionally, many hospitals maintain charitable assistance programs for patients meeting specified low-income criteria. There are federally authorized dispute resolution forums for resolving disputes related to compliance with the No Surprise Act requirements. Also, nonprofit advocacy groups assist patients in navigating complex billing processes.
However, if you have suffered an injury as a result of someone else’s negligence causing harm to you, utilizing an attorney to negotiate your medical billing charges is not optional; it is essential to maximizing your financial recovery.
Legal Assistance Post-Injury
Reducing medical billing expenses is merely one aspect of what an experienced personal injury attorney undertakes on behalf of their client. Attorneys responsible for representing clients with personal injury claims also undertake investigations regarding fault/duty; gathering evidence/evidence discovery; consulting with accident reconstruction specialists; communicating directly with opposing parties’ insurance carriers; calculating present/future economic losses (including wage loss/medical expense); and representing clients in litigation proceedings when necessary/opportune.
Throughout all aspects of providing legal assistance post-injury, attorneys aim to maximize net settlements realized by their clients, not merely the headlining settlement figure, but what ultimately remains after deducting medical expenses/lien recovery obligations.
Frequently Asked Questions
What is the first step in pursuing my claim?
You may contact our office immediately; we will provide guidance and protect your rights while you obtain treatment.
Could I owe money after my settlement?
It is possible to owe money. Medical providers often demand full reimbursement for their services. However, we attempt to reduce those amounts through negotiation. We frequently succeed in getting medical providers to accept less than they originally requested. Our objective is to minimize any debt you might incur when your claim is settled.
When should I hire a lawyer after being in an accident?
The sooner the better. Physical evidence will begin to deteriorate; some information provided by eyewitnesses may fade; the availability of medical records and other physical evidence may diminish. If we become involved in your matter at the earliest stages, we can help control your medical expenses as well as prevent future liens from attaching to your claim. There is no charge to speak with one of our attorneys. A legal fee will only be charged to you if we successfully resolve your claim.
How can I best prepare myself for the negotiation of my medical bills?
Maintain all correspondence, documents, and communication regarding your treatment. Include summaries, explanations of benefits issued by your health care plan(s), and billing statements received from each healthcare provider. Also, request detailed breakdowns (itemization) of the charges submitted by each service provider. Create a record of each time you visit a doctor or healthcare facility, along with the nature of your treatment. These records serve as a basis for negotiations with each healthcare provider.
Can Medicare or Medicaid liens be negotiated?
They sometimes can. By federal statute, Medicare and Medicaid are required to collect a specific percentage of your recovery, depending upon the type of injury you sustained and the duration of your hospital stay. Under certain conditions, however, hardship exceptions may apply. As an attorney knowledgeable in the subject of federal lien law, I can advise whether an exception exists in your situation.
About Jay Murray
Board Certified Personal Injury Trial Attorney Jay Murray has represented thousands of individuals in the Dallas/Fort Worth area for over 28 years, practicing law. His extensive background includes recovering hundreds of millions of dollars in settlements for accident victims, such as a $12 million jury verdict in a car crash lawsuit and multiple six-figure settlements resulting from truck crashes, catastrophic injuries, and wrongful deaths.
Jay Murray has earned recognition among the top trial lawyers nationally and locally. Among his professional associations are membership with the National Trial Lawyers’ Top 100 and the Multi-Million Dollar Advocates Forum. Additionally, he is listed on SuperLawyers and holds an Excellent rating on AVVO.
Jay Murray Personal Injury Attorneys has maintained its location in Uptown Dallas since opening its doors almost 18 years ago. It also maintains offices in Ennis and Forney. Jay Murray and his staff represent accident victims across Dallas County and surrounding areas.
If you have suffered a loss due to an accident and are concerned about how your medical expenses will impact your settlement proceeds, contact Jay Murray Personal Injury Attorneys today at (214) 382-0479 to arrange for a complimentary consultation.
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