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. […]
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 […]