Claims Process

Hospital and Medical Liens in Texas

A plain-language guide to the Texas hospital lien law, and to the repayment rights a health plan, Medicare or Medicaid can have when another person's conduct caused your injury.

9 min readPublished October 21, 2026Last updated October 21, 2026Edited by Joseph Budzinski, CTO, InjuryClaimGuide

The short answer

In Texas, a hospital has a lien on the claim of a person it treats for injuries from an accident attributed to another person's negligence, if the person is admitted within 72 hours of the accident (Prop. Code §55.002). The lien is limited to the lesser of the hospital's charges for the first 100 days of hospitalization, 50 percent of what the person recovers through the claim, or, if the trier of fact specifies it, the amount awarded for hospital charges less a pro rata share of attorney's fees and expenses (§55.004); to secure it, the hospital must give notice and file it with the county clerk before money is paid (§55.005). A health plan, Medicare or Medicaid may also have a right to be paid back, usually called subrogation or reimbursement.

Introduction

After a crash, the hospital that treated you, an ambulance provider, your health plan, Medicare or Medicaid may each have a right to be paid back from money you recover from the person who caused your injury. A hospital's right is called a lien. A health plan's or a government program's right is usually called subrogation or reimbursement. This guide explains what the Texas hospital lien law says, and gives a high-level view of the other repayment rights.

This article provides general informational guidance and is not legal advice. The terms of your own health plan control what it can recover, and a Texas attorney can tell you which of these rules apply to your situation.

What a Hospital Lien Is

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 that is attributed to the negligence of another person. For the lien to attach, the individual must be admitted to a hospital not later than 72 hours after the accident (Prop. Code §55.002(a)). The lien extends to both the admitting hospital and a hospital to which the individual is transferred for treatment of the same injury (§55.002(b)).

For this chapter, an injured individual is considered admitted to a hospital if the individual is allowed access to any department of the hospital for the provision of any treatment, care or service (§55.0015).

Emergency Medical Services Liens

An emergency medical services provider has a similar lien when the individual receives emergency medical services in a county with a population of 800,000 or less, not later than 72 hours after the accident (§55.002(c)). That lien is for the amount the provider charged, not to exceed $1,000, for emergency medical services provided during the 72 hours following the accident (§55.004(f)).

What the Lien Attaches To

Under §55.003(a), a lien under this chapter attaches to:

a cause of action for damages arising from an injury for which the injured individual is admitted to the hospital or receives emergency medical services;
a judgment of a Texas court, or the decision of a public agency, in a proceeding to recover damages arising from that injury; and
the proceeds of resolving that cause of action, or a claim, by agreement.

The lien does not attach to a claim under the Texas workers' compensation law, the Federal Employees Liability Act or the Federal Longshore and Harbor Workers' Compensation Act. It also does not attach to the proceeds of an insurance policy in favor of the injured individual, the individual's beneficiary or legal representative, except public liability insurance carried by the insured that protects the insured against loss caused by an accident or collision (§55.003(b)).

The written notice the hospital or provider must send you states that the lien will attach to any cause of action or claim you may have against another person for your injuries, and that the lien does not attach to real property you own (§55.005(d)).

How Much a Hospital Lien Can Be

Section 55.004 limits the amount. A hospital lien is for the lesser of (§55.004(b)):

the amount of the hospital's charges for services provided to the injured individual during the first 100 days of the individual's hospitalization;
50 percent of all amounts the injured individual recovers through a cause of action, judgment or agreement described in §55.003(a); or
if the trier of fact specifies the amount awarded for hospital charges, the amount awarded for the hospital's services, less the pro rata share of reasonable attorney's fees and expenses the injured individual incurred in pursuing the claim.

A hospital lien may also include a physician's reasonable and necessary charges for emergency hospital care provided during the first seven days of the hospitalization (§55.004(c)).

A hospital lien does not cover, among other things, charges for other services that exceed a reasonable and regular rate for the services (§55.004(d)(1)). It also does not cover certain physician charges for which the physician has accepted insurance benefits or payment under a private medical indemnity plan or program, or for which the physician is entitled to recover payment from such a plan under an assignment of benefits (§55.004(d)(2)-(3)).

How a Hospital Secures and Releases the Lien

To secure the lien, a hospital or emergency medical services provider must (§55.005(a)):

provide notice to the injured individual; and
file written notice of the lien with the county clerk of the county in which the services were provided, before money is paid to an entitled person because of the injury.

The filed notice must contain the injured individual's name and address, the date of the accident, the name and location of the hospital or provider claiming the lien, and the name of the person alleged to be liable for damages, if known (§55.005(b)). Not later than the fifth business day after the hospital or provider learns from the county clerk that the notice has been recorded, it must send written notice by regular mail to the injured individual or the individual's legal representative at the last known address. An emergency medical services provider may instead give the notice on its authorization form at the time of service, if the form meets the statute's requirements (§55.005(d)-(f)). The failure of an individual to receive a mailed notice does not affect the validity of the lien (§55.005(g)).

To discharge the lien, the hospital or provider files a certificate with the county clerk stating that the debt covered by the lien has been paid or released (§55.006).

Releases

A release of a cause of action or judgment to which a lien under this chapter may attach is not valid unless one of these is true (§55.007(a)):

the charges of the hospital or provider claiming the lien were paid in full before the release was executed and delivered;
those charges were paid before the release was executed and delivered, to the extent of any full and true consideration paid to the injured individual by or on behalf of the other parties to the release; or
the hospital or provider claiming the lien is a party to the release.

Records

On request by an attorney for a party by, for or against whom a claim for damages arising from the injury is asserted, a hospital or emergency medical services provider must make its records of the services provided to the injured individual available for the attorney's examination as promptly as possible (§55.008(a)).

Other Repayment Rights: Health Plans, Medicare and Medicaid

A hospital lien is only one kind of repayment right. The rules below are a high-level summary. Each program and plan has its own detailed rules.

Health Plans

Civil Practice and Remedies Code chapter 140 lets the issuer of a health benefit plan, a disability benefit plan or an employee welfare benefit plan contract to be subrogated to, and to have a right of reimbursement from, the covered individual's recovery for an injury caused by the tortious conduct of a third party (CPRC §140.004).

Chapter 140 limits what all such payors together may recover. When the covered individual is represented by an attorney, the payors' share is the lesser of one-half of the individual's gross recovery, or the total cost of benefits paid as a direct result of the third party's conduct, in each case less attorney's fees and procurement costs as the chapter provides (§140.005(c)). A similar limit, without the fee reduction, applies when the individual is not represented (§140.005(b)). A payor generally may not pursue recovery against the covered individual's first-party recovery (§140.008).

Chapter 140 does not apply to workers' compensation, Medicare, the Medicaid program, Medicaid managed care, the state child health plan, or a self-funded plan subject to the federal Employee Retirement Income Security Act of 1974 (ERISA) (§140.002(f)). Your plan documents state the terms that apply to your plan.

Medicare

Federal law makes Medicare a secondary payer when payment has been made, or can reasonably be expected to be made, under an automobile or liability insurance policy or plan, including a self-insured plan, or under no-fault insurance. Medicare may make a conditional payment when that other plan has not paid or cannot reasonably be expected to pay promptly, and that payment is conditioned on reimbursement (42 U.S.C. §1395y(b)(2)(A)-(B)). Under the federal regulation, if the beneficiary or another party receives a primary payment, the beneficiary or other party must reimburse Medicare within 60 days (42 C.F.R. §411.24(h)).

Medicaid

In Texas, applying for or receiving Medicaid medical assistance constitutes an assignment of the applicant's or recipient's right of recovery from another person for personal injury caused by that person's negligence or wrong. An applicant or recipient must inform the state commission that administers Medicaid of any unresolved tort claim that may affect medical needs and of any private accident or sickness insurance coverage that is or may become available, and a recipient must also inform the commission of any injury requiring medical attention that is caused by another person. The information is due within 60 days of the date the person learns of the insurance coverage, tort claim or potential cause of action. The commission's right of recovery is limited to the cost of the medical care services it paid (Hum. Res. Code §32.033(a), (b), (e)).

What You Can Gather

While you think about your next steps, it can help to keep these in one place:

Any lien notice you received by mail or signed on an ambulance form
Itemized bills from each hospital, physician and ambulance provider
Explanation-of-benefits statements from your health plan
Your health plan's member handbook or plan documents
Your Medicare or Medicaid card, if you have one, and any letters from either program about the crash
Letters or claim numbers from insurers

About InjuryClaimGuide

InjuryClaimGuide is a legal advertising service. We are not a law firm and do not provide legal advice. We do not recommend or endorse any attorney, and we do not analyze the merits of any potential claim. Routing to participating firms is based on geography, practice area, language, and firm capacity.

Frequently Asked Questions

Can a Texas hospital lien attach to my house?

The notice a hospital or emergency medical services provider must send under Prop. Code §55.005(d) states that the lien will attach to any cause of action or claim you may have against another person for your injuries, and that it does not attach to real property you own.

Does a hospital lien always equal the full hospital bill?

No. Under Prop. Code §55.004(b), a hospital lien is for the lesser of the hospital's charges for the first 100 days of hospitalization, 50 percent of all amounts the injured person recovers, or, when the trier of fact specifies an amount for hospital charges, that amount less a pro rata share of attorney's fees and expenses. The lien also does not cover charges that exceed a reasonable and regular rate (§55.004(d)).

Can my health plan be repaid out of what I recover?

It depends on the plan. CPRC chapter 140 lets many health plans contract for subrogation and reimbursement, and limits what they can recover. Chapter 140 does not apply to Medicare, Medicaid or a self-funded ERISA plan, which follow their own rules. Your plan documents and a Texas attorney can tell you which rules apply.

Can InjuryClaimGuide tell me how much I will owe on a lien?

No. InjuryClaimGuide is a legal advertising service, and we do not evaluate any claim or any lien. An attorney can advise you about your specific situation.

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