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Provider Can't Challenge Carrier's Use of Billing Code to Deny Coverage

Wednesday, January 10, 2024 | 0

The Delaware Supreme Court ruled that a medical care provider lacked legal standing to challenge an insurance carrier’s use of a billing code to deny coverage to patients as violating the workers’ compensation law. First State Orthopaedic PA is a Delaware orthopedic practice. It provided services to injured workers who were covered by policies issued by Liberty Mutual Group. In 2017 and 2018, Liberty routinely issued explanation of benefits forms to FSO using Code x553 and stating that the services were not authorized by a case manager. FSO filed suit, contending that the d...

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