454-12-2556-m4
DECISION AND ORDER Vista Hospital of Dallas (Vista) challenges the denial of additional reimbursement by Ace American Insurance Company (AAIC) for hospital outpatient services (HOPS) provided to an injured worker on December 19, 2007. Vista billed AAIC $14,770.63 for various services, including an epidural steroid injection (ESI), fluoroscopy, and related hospital services administered under CPT […]
454-12-2570-m4
DECISION AND ORDER Vista Hospital of Dallas (Vista) challenges the denial of additional reimbursement by Ace American Insurance Company (AAIC) for hospital outpatient services (HOPS) provided to an injured worker on January 30, 2008. Vista billed AAIC $14,725.08 for various services, including a selective nerve root injection (SNI) with fluoroscopic guidance and related hospital services […]
454-11-6629-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by American Home Assurance Co. (AHAC) for a lumbar caudal epidural steroid injection (ESI) via epidural catheter and fluoroscopy provided to an injured worker on January 2004, at Vista’s hospital outpatient facility (HOP) and billed under CPT Code 62311. The Administrative […]
454-12-7136-m4
DECISION AND ORDER Breckenridge Surgery Center (Provider) challenges the denial of reimbursement by __________, a self-insured entity, for services provided to an injured worker because the Provider failed obtain preauthorization. The Administrative Law Judge (ALJ) concludes that Provider did not obtain preauthorization for the procedure. Consequently, Provider is not entitled to reimbursement from ______ for […]
454-12-7137-m4
DECISION AND ORDER I. INTRODUCTION _______ requested a hearing to contest the Medical Fee Dispute Resolution decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division), denying her request for reimbursement for her out-of-pocket costs for a surgical procedure. This decision finds that _____ is not entitled to any reimbursement. II. JURISDICTION, NOTICE […]
454-11-5730-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Zurich American Insurance Company (Zurich) for outpatient (OP) services, specifically a lumbar caudal epidural steroid injection via an epidural catheter (lumbar ESI), CPT Code 62311, provided to an injured worker on July 29, 2003. The Administrative Law Judge (ALJ) finds that […]
453-03-2556-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Texas Mutual Insurance Co. (TMIC) for a shoulder surgery (CPT Code 23410) provided to an injured worker on May 22, 2001, at Vista’s ambulatory surgical center (ASC). The Administrative Law Judge (ALJ) finds that the fair and reasonable reimbursement for Vista’s […]
453-03-2820-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Texas Mutual Insurance Co. (TMIC) for a shoulder surgery (CPT Code 29826) provided to an injured worker on June 26, 2001, at Vista’s ambulatory surgical center (ASC). The Administrative Law Judge (ALJ) finds that the fair and reasonable reimbursement for Vista’s […]
453-02-3655-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Texas Mutual Insurance Co. (TMIC) for a knee surgery (CPT Code 29870) provided to an injured worker on January 24, 2001, at Vista’s ambulatory surgical center (ASC). The Administrative Law Judge (ALJ) finds that the fair and reasonable reimbursement for Vista’s […]
453-02-3716-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Texas Mutual Insurance Co. (TMIC) for a knee surgery (CPT Code 29881) provided to an injured worker on January 4, 2001, at Vista’s ambulatory surgical center (ASC). The Administrative Law Judge (ALJ) finds that the fair and reasonable reimbursement for Vista’s […]