This is a patient who presented to the emergency department (ED) with the complaint of abdominal pain, nausea and vomiting of 2-weeks duration. She has a history of sleeve gastrectomy. Surgical and Obstetrics and Gynecology (OB/Gyn) consultations were obtained. A computed tomography (CT) scan was completed showing anatomic findings of sleeve gastrectomy and no acute pathology. The health plan's determination is upheld. Her evaluation with examination, lab data and CT scan did not identify acute pathology that required inpatient admission. She was treated with IV fluid, pain and antiemetic medications with improvement. She was maintained in the hospital and remained clinically stable during this time. There is no clinical documentation to support the need for inpatient admission. The patient remained hemodynamically stable throughout this period of care, there was no fever, or documented complication.