The patient was admitted with the diagnosis of meningitis. The patient presented to the emergency department with a one-day history of nausea and severe headache with eye pain. Vital signs on presentation: temperature 100.1°, heart rate 78, respiratory rate 20, and blood pressure 136/72. The patient was admitted to the pediatric unit. He was started on intravenous (IV) ceftriaxone and IV vancomycin with a diagnosis of meningitis.

The health plan's determination is overturned. The inpatient stay was medically necessary. This patient required inpatient hospital care because at the time of admission he had severe pain requiring IV analgesia. He had distinctly abnormal CSF results showing a diagnosis of meningitis. While the lab results were more consistent with a viral meningitis, the high number of WBC in the CSF at such an early stage of the illness was concerning for bacterial meningitis as well.