The patient with diabetes and hyperlipidemia who presented to the hospital with complaints of nausea and vomiting. This was followed by a sensation of chest discomfort. She had lightheadedness after vomiting. Four days prior to the presentation, the patient had undergone a stress test, but did not know the results. The patient was admitted. The patient was seen in cardiology consultation. Per the consult note, the patient reported that that the recent stress test was abnormal. The chest pain was felt to be atypical for angina. However, in view of the elevated troponin, cardiac catheterization was recommended. This was performed and showed mild diffuse stenosis of the left anterior descending coronary artery. The health plan's determination of medical necessity is upheld in whole. The inpatient hospitalization is not medically necessary. The patient was hemodynamically stable, had chest pain, which was not typical for angina, had an EKG without diagnostic changes of acute myocardial infarction, and had borderline troponin levels. With the World Health Organization (WHO)WHO criteria cutoff for Troponin T for acute myocardial infarction (0.1). Her EKG did not show definite evidence for acute myocardial infarction. A lower level of care status was appropriate.