Texas 'Paid or Incurred' Medical Bill (CPRC § 41.0105), Lien & Net Settlement Estimator
Governing Texas Statutory Formula: CPRC § 41.0105 & Ins. Code Ch. 140
Calculate how gross hospital 'chargemaster' bills convert to admissible 'Paid or Incurred' medical evidence under Haygood v. De Escabedo (CPRC § 41.0105), and estimate net client pocket recovery after Texas Insurance Code Chapter 140 health-plan subrogation caps, Chapter 55 hospital liens, PIP additions, and contingency fees.
Interactive Paid vs. Incurred & Net Settlement Calculator
Why the Haygood 'Paid or Incurred' Rule & Chapter 140 Subrogation Caps Control Your Net Check
In Texas personal injury cases, there is often a massive gap between a hospital's gross 'chargemaster' billed amount ($120,000) and the contractual rate actually paid by BlueCross, UnitedHealthcare, or Medicare ($24,000). Under Texas Civil Practice and Remedies Code § 41.0105 and the Texas Supreme Court's ruling in Haygood v. De Escabedo, 356 S.W.3d 390 (Tex. 2011), only the $24,000 'actually paid or incurred' figure is admissible in evidence and recoverable as past medical damages; the $96,000 contractual adjustment written off by the hospital cannot be shown to the jury.
On the back end of a settlement, Texas law strongly protects your net check through two statutes: first, under Texas Insurance Code § 140.005, a non-ERISA-preempted Texas health insurer's subrogation reimbursement is capped at the lesser of (a) the benefits paid minus 1/3 for attorney's fees, or (b) 50% of the gross settlement minus 1/3 for attorney's fees (effectively capping the health plan's recovery at 1/3 of the gross settlement). Second, any Texas Personal Injury Protection (PIP) benefits you collect ($2,500 to $10,000+) are completely exempt from subrogation payback under Tex. Ins. Code § 1952.155.
Frequently Asked Questions Under Texas Law
How do Letters of Protection (LOPs) work under CPRC § 41.0105 if I don't have health insurance?
If you are uninsured or treat under a Letter of Protection (LOP), no contractual insurance write-off has occurred yet, so the provider's unpaid balance remains 'incurred' under § 41.0105—though defense counsel may challenge whether the charges exceed reasonable rates under CPRC § 18.001 and In re K & L Auto Crushers, 627 S.W.3d 239 (Tex. 2021).
Can a Texas hospital lien take 100% of my car accident settlement?
No. Under the 2019 amendments to Texas Property Code § 55.004(b), a valid 72-hour inpatient hospital lien is capped at the lesser of the charges for the first 100 days of hospitalization OR 50% of the gross third-party recovery—and a hospital lien can never attach to your Texas PIP or UM/UIM benefits (§ 55.003(b)).
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