By Guest Author Teresa Kenyon, Esq. – Director of Lien Resolution for Synergy Settlement Services
Introduction
In the world of personal injury law, every moment counts. The intricacies of building a solid case, negotiating with insurance companies, and advocating for your clients in court demand your undivided attention. Yet, there’s a persistent issue both during and after resolution of your case that often distracts you from your core responsibilities: healthcare liens. These liens, imposed by healthcare providers, government agencies, and private insurers, can become a legal labyrinth which negatively impacts the amount your injured clients will receive. This is precisely why collaborating with a dedicated Lien Resolution Specialist can be a game-changer for your practice.
We will explore the compelling reasons why you should outsource your lien resolution work to experts. We will delve into the complexities of different types of healthcare liens and how seasoned Specialists can positively impact your clients’ take-home recovery.
Understanding Healthcare Liens
Before probing into the reasons why you should engage experts for lien resolution, let’s take a step back and understand the nature of healthcare liens.
Healthcare liens are legal claims placed on a personal injury settlement or judgment by healthcare benefit providers. These liens aim to recover the medical expenses paid for by the health benefit program that were incurred by the injured party as a result of the accident or injury. The types of healthcare liens come in various forms including:
Medicaid Liens:
State-administered Medicaid programs that provide healthcare coverage to low-income individuals. When Medicaid beneficiaries are injured due to someone else’s negligence, state Medicaid programs may assert liens to recover the medical costs they’ve covered. Medicaid liens can have a substantial impact on personal injury settlements. However, case law, such as the Ahlborn and Gallardo decisions, have established the principle of proportional recovery. This means they should only claim a fair share of the settlement or judgment amount.
Medicare Liens:
Medicare is a federal program that provides healthcare coverage primarily for individuals aged 65+ and older or in specific other situations. When Medicare beneficiaries are injured, Medicare has an interest in being reimbursed for payments they conditionally made in third-party liability cases. Navigating Medicare liens requires an intricate understanding of federal law, and the potential consequences of mistakes can be severe, including double damages or referral to the Department of Treasury for collection.
Hospital Liens:
Hospitals provide medical services to injured individuals with the expectation of receiving payment for their services. In cases where individuals lack sufficient insurance coverage or face financial difficulties, hospitals may place liens on personal injury settlements or judgments to recover unpaid medical bills. Proper itemized billing is crucial to verify the accuracy of the charges. This ensures transparency and fairness in the lien resolution process and ensures that you do not overpay hospital charges.
ERISA Liens:
Employer-sponsored health insurance plans governed by the Employee Retirement Income Security Act (ERISA) may also assert liens in personal injury cases. ERISA liens can be particularly sophisticated and difficult to resolve as they involve federal regulations as well as stringent compliance requirements. Case law has clarified the obligations of plan administrators in asserting ERISA liens, emphasizing the need for active assertion of a lien interest, clear and concise policy language, and compliance with documentation requirements. Analyzing funding status and controlling documents is crucial to formulating strategies to gain leverage in negotiations.
Military and VA Liens:
Military personnel and veterans often receive medical treatment from military hospitals and VA medical facilities. When these individuals are involved in personal injury cases, the government may assert liens to recover the costs of medical care provided through military or VA healthcare systems. It’s fundamental to understand the unique jurisdiction and procedures associated with military healthcare facilities. These liens can involve complicated federal regulations. VA liens involve the Department of Veterans Affairs. It’s important to note that the laws governing VA liens can vary depending on the nature of the injury and the specific VA benefits received by the veteran.
FEHBA Liens:
The Federal Employees Health Benefits Act (FEHBA) provides health insurance coverage to federal employees and retirees. If a federal employee or retiree is injured due to the negligence of a third party, FEHBA may cover their medical expenses with the expectation that they be reimbursed from any settlement funds. FEHBA liens are governed by federal law and can be challenging to navigate. Case law that exists provides that these plans preempt state law but do not provide much other guidance.
Disability Liens:
In personal injury cases involving individuals with disability benefits, there are disability liens to consider. When these policyholders receive settlements or judgments in personal injury cases, the disability insurance company may assert liens to recover the disability benefits paid. Disability liens can present difficult legal challenges. You must navigate the terms of disability insurance policies, which can vary widely, and negotiate with insurance companies to reduce the liens and ensure clients are not unfairly burdened with repaying disability benefits that they have already received. The disability plan’s policy language and the nature of the case are important components to analyze.
Private Health Insurance Liens:
Private health insurers, such as Blue Cross Blue Shield, Aetna, or United Healthcare, provide healthcare coverage to individuals through insurance policies. In personal injury cases, these insurers may assert liens to recoup the payments made on behalf of their policyholders for medical treatment related to the injury. Understanding the terms and conditions of private health insurance policies is essential when dealing with these liens. Case law and statutory framework in each state has emphasized the need for insurers to explicitly state their subrogation rights in their policies.
Important Practice Note: It is essential to assess whether a private insurance plan is really a Medicare Advantage or Medicaid Managed Care Organization (MCO) in hiding. Those plans are not governed by state law and require your swift attention.
Navigating Complex and Evolving Laws
Healthcare lien laws are elaborate yet vague, with federal and state regulations governing different aspects of liens. These laws are subject to change, and staying up to date can be a daunting task for busy personal injury attorneys. Engaging a Lien Resolution Specialist gives trial lawyers access to the latest legal insights regarding lien resolution. Specialists keep abreast of recent case law, regulatory shifts, and evolving lien reduction strategies, enabling you to maximize your client’s recovery while focusing on what you do best.
For instance, in the complex world of Medicare or Medicaid liens, experts can calculate the appropriate proportion of the settlement that should be allocated to the lien, ensuring that clients receive their rightful share of the recovery. In hospital lien cases, experts can scrutinize itemized bills and challenge overinflated charges, leading to substantial lien reductions. Moreover, experts are skilled in identifying potential unrelated treatment or discrepancies or duplications in lien calculations on lien statements, which can result in further reductions. This attention to detail can make a significant difference in the final net amount received by the client.
Healthcare lien resolution requires a deep understanding of the specific strategies and tactics necessary for each type of lien. Lien Resolution Specialists bring this expertise to the table, tailoring their approach to the unique circumstances of each case. Each company that handles healthcare lien recovery efforts operates differently. Having an in-depth understanding of the inner workings of the recovery vendors can provide significant advantages in the negotiations.
Enhanced Client Satisfaction
When you opt to utilize an expert in lien resolution, you’re not only lightening your workload but enhancing your client satisfaction. By bringing in experts to handle lien resolution, you are demonstrating a commitment to protecting your clients’ financial interests. This can build trust and confidence, leading to greater client satisfaction. Clients are more likely to recommend attorneys who have successfully reduced their liens and ensured they received a fair portion of the settlement or judgment.
Outsourcing to Synergy is THE ANSWER
To navigate these complexities effectively and prioritize the best interests of your clients, you should engage a team of Lien Resolution experts like Synergy. By understanding the nuances of healthcare liens and the legal principles that govern them, and entrusting the resolution to experts, you are restricting the lienholders to funds only when truly entitled to reimbursement for medical expenses incurred. You are also ensuring that your client is receiving the maximum compensation they deserve.
Jason D. Lazarus is the managing partner and founder of the Special Needs Law Firm; a Florida law firm that provides legal services related to public benefit preservation, liens and Medicare Secondary Payer compliance. He is also the founder and Chief Executive Officer of Synergy Settlement Services, which offers healthcare lien resolution, Medicare secondary payer compliance services, public benefit preservation and complex settlement consulting.
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