This is a patient who presented to the emergency room (ER) with complaints of abdominal pain. Vital signs were stable. A right upper quadrant (RUQ) ultrasound revealed a gallstone and positive Murphy's sign consistent with acute cholecystitis. The the health plan's determination of medical necessity is overturned. This patient presented to the emergency room with findings of acute cholecystitis, and a decision to proceed with surgical treatment was made. The patient was treated with antibiotics and bowel rest, and a decision was made to take the patient for laparoscopic cholecystectomy. The patient required treatment with IV antibiotics and IV pain medication that warranted acute inpatient admission consistent with standard guidelines.