Medical Bills and Hospital Liens in Houston, TX Chapter 55 Limits and Amounts Actually Paid

The 72-hour condition

Property Code §55.002(a) provides that a hospital has a lien on a cause of action or claim of an individual who receives hospital services for injuries caused by an accident attributed to the negligence of another person, and that the lien attaches only if the individual is admitted to the hospital not later than 72 hours after the accident. Subsection (b) extends the lien to a hospital that receives the individual by transfer. Subsection (c) allows an emergency medical services provider lien only in a county with a population of 800,000 or less, which excludes Harris County. Admission timing, in other words, is a threshold fact, not a formality.

Three ceilings, and the one that usually binds

Section 55.004(b) states that the lien does not extend to more than the lesser of three amounts: the amount of the hospital's charges for services provided during the first 100 days of hospitalization; 50 percent of all amounts recovered by the injured individual through a cause of action, judgment, or settlement; or, where the trier of fact has specified an amount to be paid for hospital services, that amount less the pro rata share of attorney's fees and expenses the injured individual incurred in obtaining the recovery. Subsection (c) permits adding a physician's reasonable and necessary charges for emergency hospital care rendered during the first seven days. Subsection (f) caps an emergency medical services lien at $1,000.

What the lien cannot reach

Section 55.003(b)(2) provides that the lien does not attach to the proceeds of an insurance policy in favor of the injured individual or that individual's beneficiary or legal representative, except public liability insurance carried by the insured that protects the insured against claims arising from injuries or damage to person or property. Section 55.004(d) excludes charges that exceed a reasonable and regular rate for the services and excludes physician charges already covered by insurance benefits the physician has accepted as full payment. These are limits written into the statute, but applying them to a particular bill is a legal analysis, not an arithmetic exercise a rider should attempt alone.

Filing, notice, and release

Section 55.005(a) requires the hospital, to secure the lien, to give written notice to the injured individual and to file written notice with the county clerk of the county in which the services were provided before money is paid to an entitled person, which for care provided in Houston means the Harris County Clerk. Subsection (d) requires the hospital to give the individual written notice within five business days after the clerk records the notice, stating that the lien attaches to the claim and does not attach to real property. Section 55.006 provides for discharge by filing a certificate with the same clerk, and §55.007(a) makes a release invalid unless the lien charges are paid in full, paid to the extent of the consideration paid, or the lienholder is a party to the release.

The paid-or-incurred limit on recovery

Civil Practice and Remedies Code §41.0105 provides that recovery of medical or health care expenses incurred is limited to the amount actually paid or incurred by or on behalf of the claimant. A billed charge and an amount actually paid or incurred can differ substantially, which is why complete billing records, adjustments, and payment histories matter more than a single statement of the total. Section 55.008(a) helps here: on written request from an attorney or the injured individual, the hospital shall as promptly as possible make the records available for examination and copying, and may not deny access on the ground that the records are not complete.

Houston care and record-gathering

Three Level I trauma facilities in Houston appear on the Texas Department of State Health Services designated trauma facility list at 77030 in Trauma Service Area Q: Harris Health System Ben Taub Hospital, Memorial Hermann - Texas Medical Center, and Texas Children's Hospital, out of 302 designated facilities statewide and 20 Level I designations. Fondren accounts for 11 of the 906 half-mile segments on the City of Houston High Injury Network. Keep every bill, explanation of benefits, and lien notice, note the admission date and time, and take the file to the attorney who advertises on this site or another attorney of the reader's choosing. This page is general information about Texas statutes, not legal advice, and it does not evaluate any bill or lien.