454-15-3669-m4-np
DECISION AND ORDER ___ (Carrier) sought a contested case hearing regarding a Medical Fee Dispute Decision (the MFD Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MFD Decision ordered Carrier to reimburse Compliance Toxicology, LLC (Provider) $1,116.61 for services provided to an injured worker. The Administrative Law Judge (ALJ) […]
454-15-5218-m4-np
DECISION AND ORDER Affordable Hearing Care (AHC) seeks reimbursement of $12,533.60 from Petroleum Casualty Company (Petroleum) for services associated with dispensing hearing aids to a patient. Because AHC failed to timely submit its claim for payment to Petroleum in accordance with the Texas Labor Code and the rules of the Texas Department of Insurance, Division […]
454-10-0972-m4-etal
DECISION AND ORDER I. INTRODUCTION This docket was consolidated for hearing cases (hereinafter “Consolidated Docket,” listed on Attachment A) that involve the same legal issues and types of evidence. Each case purportedly[1] involves hospital outpatient services provided prior to March 1, 2008, by Vista Medical Center Hospital, Vista Hospital of Dallas, or Surgery Specialty Hospitals […]
454-15-3740-m4-np
DECISION AND ORDER This case involves services rendered by Physicians Center, PA (Physicians) 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 Indemnity Insurance Company of North America (Carrier) to reimburse Physicians in […]
454-15-0681-m4
DECISION AND ORDER This case involves challenges by numerous insurance companies (Carriers) to Medical Fee Dispute Resolution (MFDR) decisions by the Texas Department of Insurance, Division of Workers’ Compensation (DWC) ordering additional reimbursement for air ambulance services provided by PHI Air Medical (PHI). After considering the evidence and arguments presented, the Administrative Law Judge (ALJ) […]
454-13-2460-m4-etal
DECISION AND ORDER ON SUMMARY DISPOSITION This case involves a fee dispute for services rendered by Vista Medical Center Hospital (Provider) to an injured worker (Claimant). Provider seeks additional reimbursement from the Insurance Company of the State of Pennsylvania (Carrier) for services rendered to Claimant. Carrier filed a motion for summary disposition in this case, […]
454-13-1462-m4
DECISION AND ORDER ON SUMMARY DISPOSITION This case involves a fee dispute for services rendered by Vista Medical Center Hospital (Provider) to an injured worker (Claimant). Provider seeks additional reimbursement from Commerce & Industry Insurance Company (Carrier) for services rendered to Claimant. Carrier filed a motion for summary disposition in this case, arguing that Claimant […]
454-15-1586-m4-np
DECISION AND ORDER ____, a self-insured party, appeals the approval of reimbursement to Texas Health Huguley (Provider) for services provided to an injured worker because the Provider failed to obtain required preauthorization. The Administrative Law Judge (ALJ) concludes that Provider was not required to obtain preauthorization. Consequently, Provider is entitled to reimbursement. I.I. PROCEDURAL HISTORY, […]
454-15-1565-m4-np
DECISION AND ORDER _______ seeks reimbursement from Arch Insurance Company (Carrier) for medical costs she allegedly incurred after being injured at work. Over two years after her injury occurred, she sought a medical fee dispute resolution (MFDR) from the Texas Department of Insurance, Division of Workers’ Compensation (Division). The Division’s Medical Fee Dispute Resolution Findings […]
454-14-4080-m4-np
REVISED DECISION AND ORDER Dallas Independent School District (Carrier) 1 challenges the order of reimbursement to Texas Health Presbyterian Hospital of Dallas (Provider) for inpatient services provided to an injured worker (Claimant). The Administrative Law Judge (ALJ) concludes that Carrier met its burden of proof to show that the order incorrectly calculated the reimbursement amount, […]