454-12-1961-m4
DECISION AND ORDER I. INTRODUCTION Various hospitals (Providers) requested hearings on decisions by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[1] denying additional reimbursement to Providers under the Stop-Loss Exception for a hospital stay provided to an injured worker. Providers argued that reimbursement for the admission should […]
454-18-5138-m4-np
DECISION AND ORDER This case involves a dispute regarding payment for medical services provided by Healthcare Provider (HCP)covered by the worker’s compensation insurance system. The Texas Department of Insurance’s Division of Worker’s Compensation (Division) conducted a medical fee dispute resolution (MFDR) and declined to order Carrier to reimburse HCP amount of $276.03. The Administrative Law […]
454-18-2743-m4-np
DECISION AND ORDER Carrier challenges a decision of the Texas Department of Insurance, Division of Worker’s Compensation (Division) that awarded Healthcare Provider (HCP) reimbursement for a combination of several drugs compounded into a topical cream. Carrier appeared at the hearing and presented evidence in support of its position that, by compounding multiple ingredients into a […]
454-18-3323-m4-np-etal
DECISION AND ORDER Carrier challenges a decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division) that awarded Healthcare Provider (HCP) a $1,688.74 reimbursement for a compound topical cream prepared by HCP. Carrier argued that because the compound cream was not a drug approved by the Food and Drug Administration (FDA), it required […]
454-18-3509-m4-np
DECISION AND ORDER This case involves a dispute regarding payment for medical services provided by Healthcare Provider (HCP) to an injured employee (Claimant) covered by the worker’s compensation insurance system. The Texas Department of Insurance’s Division of Worker’s Compensation (Division) conducted a medical fee dispute resolution (MFDR) and declined to order Carrier to reimburse HCP […]
454-18-3077-m4-np
DECISION AND ORDER Carrier challenges the Medical Fee Dispute Findings and Decision (MFD Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MFD Decision ordered Carrier to reimburse Healthcare Provider (Provider) the additional sum of $4,579.70 for implantables used by Provider during outpatient surgery performed on an injured worker (Claimant). […]
454-18-2555-m4-np
MODIFIED DECISION AND ORDER FOLLOWING GRANT OF MOTION FOR REHEARING This case involves urine drug testing ordered by Healthcare Provider (HCP) for an injured employee covered by the workers’ compensation insurance system. The Texas Department of Insurance’s Division of Workers’ Compensation (Division) conducted medical fee dispute resolution (MFDR) and declined to order Carrier to reimburse […]
454-18-2561-m4-np
DECISION AND ORDER This case involves services rendered by Health Care Provider(HCP) to an injured person covered by the workers’ compensation insurance system. The Texas Department of Insurance’s Division of Workers’ Compensation (Division) conducted medical fee dispute resolution (MFDR) and Carrier to reimburse HCP in the amount of $335.48.[1] HCP contends it is entitled to […]
454-18-0969-m4-np
DECISION AND ORDER This case involves services rendered by (Healthcare Provider) (HCP) to an injured employee covered by the workers’ compensation insurance system. The Texas Department of Insurance’s Division of Workers’ Compensation (Division) conducted medical fee dispute resolution (MFDR) and declined to order (Carrier) to reimburse (HCP) in the amount of $13,905.00.[1] The Administrative Law […]
454-17-5716-m4-np
DECISION AND ORDER (Carrier) sought a contested case hearing regarding a Medical Fee Dispute Resolution Findings and Decision (MDR Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MDR Decision ordered Carrier to reimburse (Healthcare Provider) (Provider) $1,570.66 for services provided to an injured worker. Carrier appeals the MDR Decision […]