This is a patient with a past medical history significant for endometriosis, migraine headaches, and uterine polyps who presented to the emergency department with complaints of left flank pain and fever. She had a diagnosis of acute pyelonephritis. She continued to receive treatment with intravenous fluids and intravenous antibiotics. The health plan's determination of medical necessity is overturned in whole. The patient was septic on admission. During the hospital stay, the patient's tachycardia improved, but her blood pressure was low on several occasions.