454-12-4924-m4
DECISION AND ORDER I. INTRODUCTION This is one of four cases heard together because they involve the same basic legal issues and evidence.[1] Each case involves services rendered by Renaissance Hospitals (Renaissance) to an injured employee covered by the workers’ compensation insurance system. Each case involves a separate insurance carrier, but the same attorney represented […]
454-12-4925-m4
DECISION AND ORDER I. INTRODUCTION This is one of four cases that were heard together because they involve the same basic legal issues and evidence.[1] Each case involves services rendered by Renaissance Hospitals (Renaissance) to an injured employee covered by the workers’ compensation insurance system. Although each case involves a separate insurance carrier, the same […]
454-12-5454-m4
DECISION AND ORDER I. INTRODUCTION This is one of four cases heard together because they involve the same basic legal issues and evidence.[1] Each case involves services rendered by Renaissance Hospitals (Renaissance) to an injured employee covered by the workers’ compensation insurance system. Each case involves a separate insurance carrier, but the same attorney represented […]
454-12-5501-m4
DECISION AND ORDER I. INTRODUCTION This is one of four cases heard together because they involve the same basic legal issues and evidence.[1] Each case involves services rendered by Renaissance Hospitals (Renaissance) to an injured employee covered by the workers’ compensation insurance system. Each case involves a separate insurance carrier, but the same attorney represented […]
454-12-6318-m4
DECISION AND ORDER Hill Country Healthcare (Provider) challenges the denial of reimbursement by _______(_____), a self-insured entity, for services provided to an injured worker because the Provider failed to obtain preauthorization. The Administrative Law Judge (ALJ) concludes that Provider did not obtain proper preauthorization. Consequently, Provider is not entitled to reimbursement. I.JURISDICTION, NOTICE, AND PROCEDURAL […]
454-12-1389-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Ace American Insurance Company (Ace) for hospital outpatient procedures (HOP) performed at Vista’s facility on three separate occasions for the same injured worker. The services were provided on March 20, 2007;[1] on May 17, 2007;[2] and on August 9, 2007.[3] […]
454-12-1391-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Ace American Insurance Company (Ace) for hospital outpatient procedures (HOP) performed at Vista’s facility on three separate occasions for the same injured worker. The services were provided on March 20, 2007;[1] on May 17, 2007;[2] and on August 9, 2007.[3] […]
454-12-2547-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Ace American Insurance Company (Ace) for hospital outpatient procedures (HOP) performed at Vista’s facility on three separate occasions for the same injured worker. The services were provided on March 20, 2007;[1] on May 17, 2007;[2] and on August 9, 2007.[3] […]
454-11-4876-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Ace American Insurance Company (AAIC) for hospital outpatient services (HOPS) provided to an injured worker on May 12, 2002. Vista billed AAIC $5,235.03 for various services, including an epidural steroid injection (ESI), fluoroscopy, and related hospital services administered under CPT Code […]
454-11-5777-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Ace American Insurance Company (AAIC) for hospital outpatient (HOP) services provided to an injured worker on November 26, 2002. Vista billed AAIC $16,142.50 for various services, including an epidural steroid injection (ESI) fluoroscopy and lumbar discogram and related hospital services. […]