CompFox AI Summary
Defendant appealed an administrative law judge's order allowing partial payment of a medical lien. The defendant argued it was not liable because the applicant received treatment outside its Medical Provider Network (MPN), and the lien claimant was not part of that network. The Appeals Board granted reconsideration, finding the defendant provided sufficient notice of its MPN to the applicant. Furthermore, the lien claimant failed to prove the medical services were reasonably necessary or that the claimed fees were reasonable. Consequently, the Board reversed the prior order and disallowed the lien claim in its entirety.
Full Decision Text1 Pages
Defendant appealed an administrative law judge's order allowing partial payment of a medical lien. The defendant argued it was not liable because the applicant received treatment outside its Medical Provider Network (MPN), and the lien claimant was not part of that network. The Appeals Board granted reconsideration, finding the defendant provided sufficient notice of its MPN to the applicant. Furthermore, the lien claimant failed to prove the medical services were reasonably necessary or that the claimed fees were reasonable. Consequently, the Board reversed the prior order and disallowed the lien claim in its entirety.
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