This is a patient with a history of obesity who presented to the emergency department (ED) with a complaint of bilateral thigh pain for one day. The patient reported that she had a cough and fever 2 weeks prior and was prescribed Tamiflu and Prednisone taper. The patient stopped the steroids because she felt better then restarted them once the cough returned. She first felt left thigh pain followed by right thigh pain. She also reported sharp neck and back pains as well as the inability to ambulate without assistance. The health plan's determination of medical necessity is upheld. There were no acute findings or clinical criteria that required inpatient care in this case. The patient did not have any alarming signs or symptoms that required an inpatient admission. The generally accepted practice would be outpatient treatment and follow-up, given the lack of signs or symptoms of impending neurological or muscular compromise. This patient could have been treated at a lower level of care.