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 […]
454-10-3238-m4
DECISION AND ORDER Integra Specialty Group, P.A. (Provider) requested a hearing to contest a medical fee dispute resolution order issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division) regarding medical services provided to __. (Claimant). In its order, the Division found that Provider was entitled to reimbursement only in the amount of […]
454-10-1574-m4
DECISION AND ORDER I. INTRODUCTION Petitioner ___ requested a hearing to contest the decision by Medical Fee Dispute Resolution of the Texas Department of Insurance, Division of Workers’ Compensation denying payment for chiropractic treatment. The hearing convened on April 19, 2010, and the record closed on April 23, 2010, to allow the parties to provide […]
454-09-5024-m4
DECISION AND ORDER Killeen Injury Clinic (Provider) requested a hearing to contest a medical fee dispute resolution order issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division) regarding $5,265.80 in medical services provided to ___ (Claimant). In its order, the Division found that Petitioner was not entitled to reimbursement from Union Standard […]
454-09-5469-m4
DECISION AND ORDER Petitioner, Injury One Treatment Center (Injury One) seeks reimbursement for health care services it provided the Claimant, ____. The Administrative Law Judge (ALJ) finds the Respondent, Fidelity & Guaranty Insurance (Fidelity) should be required to reimburse Injury One an additional $2,216.17, for the reasons described below. I. HISTORY, JURISDICTION, AND NOTICE The […]