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 […]
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 […]