This is a patient who was brought to emergency department (ED) by ambulance with complaints of flank pain. Associated symptoms included nausea. A computed tomography (CT) scan-showed a right sided ureterovesical junction (UVJ) stone with hydroureteronephrosis. He was afebrile and hemodynamically stable on presentation. His white blood cell count (WBC) and creatinine were normal. An examination revealed costovertebral angle tenderness. The health plan's determination of medical necessity is upheld. This patient did not present with hemodynamic instability, renal failure, severe obstruction, sepsis or unstable medical problems requiring inpatient management. The hospital course was essentially normal without any significant complications or major issues with pain control.