This form is a Medical Lien Agreement. The clien authorizes a health care provider to furnish his/her attorney with prepaid copies of certain medical records relevant to the client's injury or accident. The client also acknowledges that he/she is directly responsible to the health care provider for all medical bills submitted by them for services rendered.
Alaska Patient - Attorney Medical Lien Agreement
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How to fill out Patient - Attorney Medical Lien Agreement?
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FAQ
You must receive treatment in the first 72 hours (3 days) following an injury for a hospital to be able to attach a lien. If you receive treatment more than 72 hours after your injury, the hospital lien can't attach and is invalid.
A medical lien, in short, is the ability of a healthcare provider (doctor, radiologist, hospital, etc.) to place request for payment on your personal injury claim to recoup any money that is owed to them for treatment as a result of that specific accident.
Even with medical insurance, Nevada law allows the hospital to record a lien upon any real estate you own, including your home. The hospital doesn't have to warn you before placing this lien. But because this lien isn't subject to legal oversight, the hospital must carefully follow the legal procedures.
You will usually be required to provide a Letter of Protection or a signed contract stating you will pay the provider the amount owed once your claim settles. A healthcare provider will ?perfect? their lien by sending a notice of hospital lien to the insurer and interested parties.
Even if the patient never admitted to the emergency room, any lab work or radiology scans would be enough for the hospital to file a lien. A hospital lien does not extend to charges that exceed a ?reasonable and regular rate? for the services provided.
The hospital lien statute is found in Chapter 55 of the Texas Property Code. Section 55.002 gives hospitals a lien on a cause of action or a claim of anyone ?who receives hospital services for injuries caused by an accident that is attributed to the negligence of another person?.
Filed in the County Where Services were Rendered: The lien must be filed with the county clerk's office in the county where the patient received treatment. If it's filed in a different county, the hospital lien may be deemed invalid per Texas hospital lien statute.
If you were at fault for the injury, then the lien cannot attach to your property. It only attaches to a claim for compensation that you have against another party for your injuries. You still need to make arrangements to settle your account or there are other legal remedies the hospital may pursue.