Arizona Medical Lien Law for Outpatient Providers (2026)

Arizona gives a statutory lien to any state-licensed health care provider, so chiropractors, physical therapists, physicians, imaging centers and licensed surgery centers can all lien a patient's injury claim. The lien only holds if it is recorded with the county recorder within 30 days of the first visit, and for services after 2022 the law exempts one-third of the recovery and requires the provider to negotiate a fair compromise. A 2026 appeals court ruling added a strict content requirement that is now under Arizona Supreme Court review.

At a glance

Is there a lien law for outpatient providers?

Yes. A.R.S. § 33-931(A) gives a lien to every person or entity that "provides health care services in this state and that has been duly licensed by this state," plus licensed ambulance services. It is not limited to hospitals. The statute does not list provider types by name, so coverage turns on state licensure.

The lien is for the provider's "customary charges." It attaches to "all claims of liability or indemnity" for the injury. It does not reach the patient's own health insurance, medical payments (MedPay) coverage, or uninsured and underinsured motorist coverage.

A few details matter for outpatient practices:

• The $250 threshold. Hospitals can lien all customary charges. All other providers can lien only customary charges above $250, not counting interest and service charges (§ 33-931(C)).
• Hospitals go first. A hospital's perfected lien is paid ahead of all other liens under the article (§ 33-931(D)).
• No workers' compensation. The lien article does not apply to injuries covered by workers' compensation (§ 33-935).

How a lien is perfected

The provider records a verified written statement with the recorder in the county where the provider is located (A.R.S. § 33-932(A)). A non-hospital provider must record "before or within thirty days after the patient has received any services relating to the injuries." Hospitals record within 30 days after discharge.

The 30-day clock starts at the first visit. In Premier Physicians Group v. Navarro (2016), the Arizona Supreme Court rejected a rolling deadline, and the late-recorded lien in that case was invalid.

The statement must include:

• the patient's name and address;
• the provider's name and location, and its executive officer or agent, if any;
• the dates of service and the amount claimed;
• for non-hospital providers, the names and addresses of the parties claimed to be liable and their insurers, as far as the provider knows;
• the amount due as of recording; and
• a statement of whether treatment "has been terminated or will be continued." Amounts from continued treatment are also covered.

That last item is strictly enforced. In HonorHealth v. Abboud (Ariz. App. Feb. 24, 2026), the Court of Appeals held that listing dates of service does not satisfy it, that substantial compliance is not enough, and that the rule covers hospitals and all other providers. The ruling came at the motion-to-dismiss stage of a putative class action.

Within 5 days after recording, the provider mails a copy by first-class mail to the patient. A non-hospital provider also mails a copy to every party claimed to be liable and to their insurers (§ 33-932(C)). If a non-hospital provider does not record as required, the lien "is invalid and may not be enforced." The late-recording relief in § 33-932(D) applies only to hospitals and ambulances.

Once perfected, the lien has teeth (A.R.S. § 33-934):

• A patient's release of the claim is not valid against the lien unless the provider joins in it.
• The provider may sue the liable party or its insurer, within 2 years after the judgment or settlement.
• The defendant may dispute the lien as wrong, as above customary charges, or as covering care that was not medically necessary or related to the injury.
• This lawsuit runs only against those liable to the patient, not against the patient (Blankenbaker v. Jonovich, 2003).

A satisfied lien must be released within 30 days. Failing to release it carries $100 plus actual damages (§ 33-936).

Limits on what the provider is paid

For services provided after December 31, 2022, Arizona sharply limits lien recoveries (Laws 2022, ch. 340):

• Customary charges only. Charges can be challenged as higher than customary (§ 33-934(B)).
• One-third is exempt. "One-third of any third-party judgment, settlement or award is exempt from any lien or assignment" (§ 33-931(E)(1)).
• Mandatory compromise. The provider, the patient and the patient's attorney "shall compromise" the lien to reach a settlement that is "fair and equitable to all parties" (§ 33-937). The provider must weigh 11 factors, including the injury, the available liability limits, payments already received, the customary charges, the total recovery, other liens, attorney fees and costs, and reductions by other claimants.
• Proposed distribution. On request, the patient must give the provider a proposed distribution of the settlement. If the parties cannot agree, any party may ask a court to set the compromise, and attorney fees are not shifted.
• Insurance waivers count. If the patient and provider agreed not to use the health insurance, its availability may not be considered in the compromise.
• Overall cap. The provider cannot recover more than the lien, or more than the defendant owes under the judgment or settlement (§ 33-934(B)).

Lien agreements and letters of protection

The statutory lien does not replace a contract. The lien article "does not affect the rights of a health care provider to enforce a consensual agreement, whether called a lien or contract, against the patient who has signed the agreement" (§ 33-931(F)).

In Blankenbaker v. Jonovich, the Arizona Supreme Court held that an unperfected statutory lien cannot be enforced through § 33-934. It also held that a separate patient agreement was not invalid "simply because it did not create a statutory lien," and that "the provider can always proceed, even in the absence of a lien, against the patient for the value of the services rendered."

The State Bar of Arizona treats a letter of protection or an assignment that the lawyer knows about as a "matured" interest the lawyer must protect. An unsigned, unrecorded medical lien is not (State Bar of Arizona, ER 1.15 best practices).

The attorney's duty to pay the provider

The statute names the patient's attorney as an "interested party" who "shall compromise" the lien (§ 33-937(A)). And because a release that leaves out the provider does not defeat a perfected lien, the liable insurer stays exposed if the provider is skipped (§ 33-934(A)).

On the ethics side, the State Bar's guidance under ER 1.15, citing Ethics Opinions 98-06 and 11-03, says a lawyer must protect a third party's interest in settlement funds once it is a "matured legal or equitable claim" the lawyer actually knows about, such as a recorded or signed lien, an assignment, or a letter of protection. Lawyers are not required to search public records for medical liens (State Bar of Arizona).

Health insurance, no-fault and billing the patient

Arizona ties lien rights to network status (§ 33-931(E)(2)–(3)). If the patient has health insurance and the provider is in-network, the network contract "must expressly allow" a lien, or the lien "is invalid." That rule does not apply if:

• the services are not covered by the plan;
• the provider is not in-network;
• the patient has no coverage; or
• the patient and provider signed a written election not to use the coverage.

Even when the lien is otherwise invalid, the provider may lien the amounts the patient personally owes, including coinsurance, copays and deductibles (§ 33-931(E)(4)).

On AHCCCS (Medicaid) patients, the Arizona Supreme Court in Abbott v. Banner Health Network (2016) assumed, without deciding, that federal law preempts provider liens against those patients' injury recoveries, and it upheld settlements patients had signed to get lien releases.

After the case, a signed patient agreement can be enforced against the patient (§ 33-931(F)), and the provider may sue the patient for the value of services (Blankenbaker). We could not confirm in a primary source how health plan network contracts affect billing an in-network patient after the case.

Billed vs. paid medical damages

Arizona lets the injured person claim the full billed amount. In Lopez v. Safeway Stores (Ariz. App. 2006), the court held the plaintiff "was entitled to claim and recover the full amount of her reasonable medical expenses," and amounts written off under insurer contracts are a collateral source that does not reduce damages.

Medical malpractice cases are different: the defendant may introduce collateral-source benefits (A.R.S. § 12-565).

Recent changes

• SB 1021 (Laws 2022, ch. 340). Signed July 6, 2022. It added MedPay to the excluded coverages, created the one-third exemption and the in-network rule, and added the § 33-937 compromise. It applies to liens for services provided after December 31, 2022, so it governs every lien for care from 2023 on (chaptered text).
• HonorHealth v. Abboud (Ariz. App. Feb. 24, 2026). Every recorded lien, hospital or not, must include a separate statement of whether treatment has ended or is continuing. A petition for review is pending in the Arizona Supreme Court (No. CV-26-0092-PR), so this holding could change.

What this means for your practice

• Record once, early and correctly. File with the county recorder before the first visit or within 30 days of it. Later visits do not restart the clock. Mail copies to the patient, the at-fault parties and their insurers within 5 days.
• State whether treatment is ending or continuing. After Abboud, dates of service alone are not enough. Watch for the Arizona Supreme Court's decision on review.
• Check network status before treating on a lien. If you are in-network with the patient's plan and the contract does not allow liens, the lien is invalid unless an exception applies, such as a signed election not to use the insurance.
• Plan for reductions on post-2022 care. One-third of the recovery is off-limits, and the law requires a fair and equitable compromise. You can ask for the patient's proposed distribution.
• Get a signed patient agreement too. Section 33-931(F) and Blankenbaker keep a contract claim against the patient alive even if the statutory lien fails.
• Track the 2-year deadline. A § 33-934 action against the liable party or insurer must be filed within 2 years after the judgment or settlement.

Sources

1. Arizona Revised Statutes, A.R.S. § 33-931
2. Arizona Revised Statutes, A.R.S. § 33-932
3. Arizona Revised Statutes, A.R.S. § 33-934
4. Arizona Revised Statutes, A.R.S. § 33-935
5. Arizona Revised Statutes, A.R.S. § 33-936
6. Arizona Revised Statutes, A.R.S. § 33-937
7. Laws 2022, ch. 340 (SB 1021)
8. Arizona Revised Statutes, A.R.S. § 12-565
9. Premier Physicians Group, PLLC v. Navarro, 240 Ariz. 193, 377 P.3d 988 (2016)
10. Blankenbaker v. Jonovich, No. CV-02-0340-PR (Ariz. 2003)
11. HonorHealth v. Abboud, No. 1 CA-SA 25-0331 (Ariz. App. Feb. 24, 2026)
12. Abbott v. Banner Health Network, No. CV-15-0013-PR (Ariz. 2016)
13. Lopez v. Safeway Stores, Inc., No. 2 CA-CV 2005-0057 (Ariz. App. 2006)
14. State Bar of Arizona, ER 1.15 Safekeeping Property best practices (citing Ethics Ops. 98-06, 11-03)

How we verified: the full current text of A.R.S. §§ 33-931 to 33-937 and § 12-565 was read on the official Arizona Legislature site (azleg.gov); court opinions are linked to their FindLaw and CourtListener copies.