The patient is a man who presented to the hospital. He presented with a chief complaint of leg infection attributable to a spider bite. He reported seeing a brown spider bite his right lower extremity and stated that he had worsening redness, swelling, and lymphangitis to the groin. He denies shortness of breath, nausea, vomiting, fever and diarrhea. Vital signs showed blood pressure 117/76, heart rate 128, temperature 98.7 Fahrenheit, and respiratory rate 19. On physical examination, heart was regular, breath sounds were normal, there was a small wound on the lower lateral leg with a large area of erythema/rash with lymphangitis tracking up to the groin. The leg was warm and sensation was intact and equal bilaterally. Labs showed sodium 126, potassium 4.9, calcium 8.8, white blood count (WBC) 12.6, hemoglobin 15.2, platelets 144, and Creatinine 1.37. Computed tomography (CT) of the right lower extremity demonstrated subcutaneous infection with no drainable collection. Ultrasound of the right lower extremity was negative for deep vein thrombosis (DVT). The patient was admitted for right lower extremity cellulitis. The plan of care included intravenous (IV) antibiotics, infectious disease consult, IV fluids, and monitor creatinine. The Infectious disease service recommended modifying his antibiotics. Surgery was consulted to rule out necrotizing fasciitis, and blood cultures were also sent. The erythema improved and he was discharged. The health plan's determination of medical necessity is upheld in whole. Yes, the health plan has acted reasonably, with sound medical judgement in the best interest of the patient. The reason is that the patient had cellulitis in the setting of mildly elevated creatinine and hyponatremia, but he was hemodynamically stable, there was no evidence of necrotizing fasciitis, no evidence of abscess, no evidence of infection caused by resistant organisms, and no other significantly complicating factors. In addition, there was no evidence of systemic toxicity or end organ injury. Unless there are complicating comorbidities, which were not present in this patient, treatment could have been completed at a lower level of care.