The Advocate, Journal of the Nevada Trial Lawyer’s Assoc., Feb. 2008 issue.
 
NRS 449.757 went into effect on October 1, 2007.  As discussed below, this new statute will hopefully curb some of the collection agency abuses that were taking place with regard to hospital liens.  Anyone whose practice focuses primarily on personal injury cases must be familiar with this new law.
 
A brief history from this writer’s perspective on the hospital lien situation in Nevada may be helpful.
 
When I first began to practice law in 1978, things were much different vis a vis attorneys and hospital liens.   The younger readers will find this hard to believe, but,  back then, most everyone had decent health insurance.  If you were, say, an  unskilled worker, and you got a job at Sears as a sales clerk, you got health insurance – and not HMO, gimmick health insurance, but real health insurance.  In those days, skilled tradesmen belonged to labor unions, and the unions had the power to make sure the construction companies were hiring union workers and  paying benefits.  So, by and large,  if someone went to the emergency room after a car accident, the hospital was able to bill  to a health insurance and be paid a reasonable amount.  On injury  cases where the patient was not insured, and there was an unpaid hospital bill of some kind, the attorney would often   be able to call   the person at the hospital handling such affairs and work out some sort of compromise of the bill.   I am sure those “good old days” weren’t as good as I am remembering them, but permit an old timer his fond memories, please.
 
Then, as we headed into the 90s, the widespread availability of health insurance  ended.  The reimbursement rates for hospitals began to go down, way down.  Suddenly, hospital emergency rooms became primary care centers for persons without insurance. This, of course, began to put a big squeeze on hospital revenue from ER patients. 
   
I have heard different statistics about how many people in the general population have no health insurance now.  From my own personal observations, I am going to guess it is somewhere near one out of three ER patients (I know I have read government statistics putting it somewhat lower, but talk to your friends who work in a busy ER, and they will tell you differently.)
 
The County hospital system, always under the scrutiny of the media, for a long time tried to blame  easy targets for the  problem.  Politicians would say that the  people doing the collections were not aggressive enough.  Or hospital publicists would say the  lawyers were to blame, driving up malpractice rates and causing unnecessary testing to be done.  County Commission meetings were full of speakers  demanding that the collections department at the County Hospital get meaner and tougher.  Hospitals in general, and county hospitals in particular, ordered their collection people to be more “cut-throat” in their tactics.  The animosity between hospital collection persons, and p.i. attorneys, and tactics employed by both sides, became, in my opinion, more and more extreme as time went on.  (I think now everyone is seeing the bigger picture, that it wasn’t lawyers causing malpractice cases  causing the flow of red ink at county hospitals;   it is the larger sickness of the American economy as a whole, where we have hundreds of thousands of uninsured people in Clark County alone.) 
 
So, what is the current state of the law?
 
We start with NRS 108.590.  That law basically states that whenever a person receives hospitalization because of an injury, the hospital has a lien on the personal injury case.  Note that this particular lien is not limited to county hospitals; it applies to any hospital. 
 
Of particular interest to the practitioner should be the case of Humana v. Nguyen, 102 Nev. 507.  This 1986 case stated that even if the hospital was not diligent in perfecting its lien by sending notice in a timely manner, the lien is still valid.  Although the nuances of  this case can be debated, I have always taken it to mean that if you are an attorney, and your client goes to a hospital emergency room, whether or not you or your client gets a notice of the lien before the settlement is made, you, as the attorney, better pay attention to the potential  hospital lien .
 
The case of Washoe Medical Center v. Reliance Insurance Company, 112 Nev. 494, made clear that the hospital lien powers under NRS 108.650 did not extend to the patient’s own first party uninsured motorist coverage
 
NRS 108.662 gives county hospitals the right to not only have a lien against the personal injury case but also gives them the right to put a lien on the real property of the patient for the unpaid balance of an injury case related bill .  (In the most recent legislative session, I believe there were allegations made that the county hospitals took too much advantage of  their powers under this statute, putting liens upon the real property of virtually any patient coming into the trauma center for treatment of injuries that might be related to a personal injury case, even if that person had good health insurance.) The new law, NRS 449.757,  states that when a person receives hospital care (note:  this isn’t limited to just  county hospitals, but any hospital), the “hospital must not proceed with any efforts to collect on any amount owed to the hospital for the hospital care from the responsible party, other than for any co-payment or deductible, if the responsible person has health insurance or may be eligible for (government programs paying medical bills), until the hospital has submitted a bill to the insurance company or public program and the insurance company or public program has made a determination concerning payment of the claim.”
 
Although this is a great piece of consumer legislation for all patients (not just personal injury victims), it is clear that the county  hospitals can no longer put liens on real property  before the health insurance has paid; or try to avoid health insurance write-offs by going directly to the tortfeasor carrier, as has been done in the past. 
 
So, then, to summarize.   If your client went to an emergency room or trauma center following an accident, you and your client have to pay attention to the lien on the third-party (not UM) personal injury case.   Under the Nguyen case, the lien is still valid whether or not it was “perfected.”  
 
On the other hand, the hospital has to bill your client’s health insurance, or, if your client is eligible for Medicare or  Medicaid, submit the bill to them.   After the health insurance pays, or the Medicaid eligibility is established, etc., and it is determined how much the hospital is owed after contractual  write-offs, then that is the amount you have to pay on the lien.