HOW DO I GET TREATED
IF I CAN'T PAY?

Medical liens and letters of protection

Many California providers — orthopedists, pain management physicians, chiropractors, imaging centers, physical therapists, and some surgeons — will treat injury patients on a lien.

The arrangement: the provider treats you now and agrees to be paid out of your settlement or judgment later, rather than billing you as the treatment happens. Your attorney typically sends a letter of protection confirming that the provider's bill will be addressed from the recovery.

The advantages. You get treated. Your injuries are documented as they develop, which is essential evidence. And you don't have to choose between medical care and rent.

The tradeoffs. Lien providers often bill at higher rates than an insurer would pay. Those bills come out of your recovery at the end, which reduces your net. And in a case where liability is genuinely contested, you carry some risk.

A practical note: treatment on a lien is common, legitimate, and how a large share of injury cases get handled. But defense lawyers do argue that lien treatment is driven by litigation rather than medical need. Consistency in your treatment, and a provider who documents well, matters.

Medical payments coverage

Check your own auto policy for "medical payments" or "MedPay."

It's optional in California, usually inexpensive, and it pays your medical expenses up to the limit regardless of who caused the crash. Common limits run from $1,000 to $25,000 or more.

It pays quickly, which matters when bills are arriving. It typically carries a reimbursement right, meaning the carrier may seek repayment from your recovery. But it gets you treated without waiting for a liability determination.

Look at your declarations page. People frequently have this and don't know it.

Using your health insurance

If you have coverage, use it. There's a widespread and costly misconception that you shouldn't use health insurance for accident-related treatment.

Your health plan almost certainly negotiated rates far below what a provider bills, which means less gets deducted from your recovery at the end than under a lien arrangement.

The catch is that health plans generally have reimbursement or subrogation rights — they get paid back from your settlement for what they spent. How strong that right is depends on the type of plan, and plans governed by federal law can have broader rights than others. This is worth having someone actually look at rather than guessing.

Medi-Cal and Medicare

Both have statutory reimbursement rights, and both have specific procedures.

Medi-Cal has a right to recover from a third-party settlement, with a statutory framework governing how much it can take and how its claim is reduced to account for attorney's fees and costs.

Medicare operates under federal secondary-payer law. Its interests must be addressed before a case resolves, and failing to do so creates real problems — for you and for your lawyer. Where future treatment is anticipated, Medicare's future interests may also require consideration.

These are procedurally technical and are a substantial reason to have a lawyer on a case involving public benefits.

Hospital liens

California hospitals have a statutory right to assert a lien against a third-party recovery for emergency and ongoing care. There are notice requirements and limits on the amount, and hospital liens are frequently asserted incorrectly or in excessive amounts.

They're also frequently reducible. Don't assume the number on the lien notice is the number that gets paid.

The part that determines what you keep

Here's what people don't realize until the end: negotiating liens down is often worth more to your net recovery than squeezing the last few thousand out of the settlement.

A case that settles for $100,000 with $40,000 in unreduced liens nets you less than a case that settles for $90,000 with liens negotiated to $20,000. Providers, health plans, and hospitals will frequently accept reduced amounts — particularly where policy limits constrain the recovery or where the lien would otherwise consume the client's entire share.

This is unglamorous work that happens after the headline number is agreed. It's also where a meaningful amount of client money is won or lost.

One more thing

There's a California rule governing how much you can claim for medical expenses that turns on what was actually paid or accepted, not what was billed. It matters differently depending on whether you were insured or treated on a lien, and it can move a case's value substantially.

It's genuinely technical. The short version: how you pay for treatment affects what you can recover for it, which is another reason to get advice early rather than after the bills pile up.