The patient with a history of sickle cell disease presented to the hospital with worsening shortness of breath. It was determined that she was in sickle cell crisis. She was admitted to the hospital. The health plan denied the inpatient admission as not medically necessary. The health plan's determination is upheld. The inpatient admission was not necessary. The patient began improving in the emergency department and there were no other concerning symptoms such as acute evidence of infection, evidence of end organ injury, or other acute abnormalities that would increase the risk of an adverse event in this patient.