A lien is a claim against your eventual settlement. Hospitals, health insurers, Medicaid, Medicare, and certain medical providers can all assert liens depending on the situation. The lien must be addressed at settlement (paid, negotiated down, or contested) before the client receives the net recovery.
Hospital liens in Missouri (RSMo § 430.225) attach automatically when a hospital provides care for accident injuries and the patient pursues a third-party claim. The lien is for the unpaid balance of the bill, capped at a percentage of the settlement.
Health insurance liens are usually subrogation claims. Medicaid liens are federal and cannot be ignored or waived. Medicare liens have their own elaborate procedure.
The total of all liens is what comes out of the gross settlement before the client's net. A $50,000 settlement with $10,000 in liens and $16,500 in attorney fees produces roughly $23,500 net to the client. Knowing the lien picture before settling matters.