453-02-3036-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Texas Mutual Insurance Co. (TMIC) for a lumbar discogram provided to an injured worker on February 2, 2001, at Vista’s ambulatory surgical center (ASC). The Administrative Law Judge (ALJ) finds that the fair and reasonable reimbursement for Vista’s services rendered in […]
453-02-3779-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Texas Mutual Insurance Co. (TMIC) for a lumbar discogram provided to an injured worker on February 2, 2001, at Vista’s ambulatory surgical center (ASC). The Administrative Law Judge (ALJ) finds that the fair and reasonable reimbursement for Vista’s services rendered in […]
453-02-3976-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Texas Mutual Insurance Co. (TMIC) for a cervical discogram provided to an injured worker on February 19, 2001, at Vista’s ambulatory surgical center (ASC). The Administrative Law Judge (ALJ) finds that the fair and reasonable reimbursement for Vista’s services rendered in […]
453-03-0306-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Texas Mutual Insurance Co. (TMIC) for an epidural steroid injection (ESI) provided to an injured worker on April 6, 2001, at Vista’s ambulatory surgical center (ASC). The Administrative Law Judge (ALJ) finds that the fair and reasonable reimbursement for Vista’s services […]
453-03-0307-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Texas Mutual Insurance Co. (TMIC) for an epidural steroid injection (ESI) provided to an injured worker on February 22, 2001, at Vista’s ambulatory surgical center (ASC). The Administrative Law Judge (ALJ) finds that the fair and reasonable reimbursement for Vista’s services […]
453-03-0330-m4
DECISION AND ORDER Vista Healthcare, Inc. (Vista) challenges the denial of additional reimbursement by Texas Mutual Insurance Co. (TMIC) for an epidural steroid injection (ESI) provided to an injured worker on April 6, 2001, at Vista’s ambulatory surgical center (ASC). The Administrative Law Judge (ALJ) finds that the fair and reasonable reimbursement for Vista’s services […]
454-11-6493-m4
DECISION AND ORDER Old Republic Insurance Company (Carrier) requested a hearing to contest the Medical Fee Dispute Resolution decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division), ordering reimbursement for medications purchased by _____ (Claimant) from June 17, 2010, through August 31, 2010. This decision finds that Claimant is not entitled to […]
454-09-3932-m4
DECISION AND ORDER Zurich American Insurance Company (Carrier) requested a hearing to contest a Medical Fee Dispute Resolution (MDR) decision issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division) regarding medical services provided to an injured worker (Claimant). In its order, the Division determined that Carrier owed an additional $8,881.38 to Summit […]
454-11-2791-m4
DECISION AND ORDER Trophy Club Medical Center (Provider) requested a hearing to contest the Medical Fee Dispute Resolution decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division) ordering additional payment of only $12,849.85. Provider contends it is entitled to payment of another $25,000 for reimbursement for medical implantables. After considering the evidence […]
454-10-4433-m4
DECISION AND ORDER I. INTRODUCTION ______ (Requestor) requested a hearing to contest the Medical Fee Dispute Resolution decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division), denying payment for home health care services she provided to ____. This decision finds that Requestor is not entitled to any reimbursement. II. JURISDICTION, NOTICE AND […]