Diagnosis: Chest Pain

Treatment: Inpatient Admission

The insurer denied the inpatient admission. The denial was upheld.

This is male patient with a medical history of hypertension, immunodeficiency, depression, anxiety, and substance abuse. He presented to the hospital with complaints of chest pain for two days. He described the pain to be intermittent, sharp and present at rest. His presenting vital signs were stable. Serial troponin levels were drawn with negative results. An electrocardiogram (EKG) was performed that showed sinus bradycardia. An echocardiogram was done with negative results. The patient was treated for oral candidiasis. He was evaluated by psychiatry for vague symptoms of suicidal ideations. He was medical stable and discharged home.

The patient presented with chest pain. The initial evaluation in the ER was unremarkable, including non-diagnostic EKG and cardiac biomarkers. Inpatient admission was not medically necessary for this patient. The patient's care could have been provided in the observational setting, allowing for additional diagnostic testing. Further evaluation was warranted, however inpatient admission was not. There was no hemodynamic instability, cerebrovascular insufficiency, hypoxemia requiring supplemental oxygen or support, myocardial ischemia, or other medical conditions warranting acute inpatient level of care.

The health care plan acted reasonably and with sound medical judgment and in the best interest of the patient.

Based on the above, the medical necessity for the inpatient hospital admission from is not substantiated. The insurer's denial is upheld.