Diagnosis: Vision/poor vision
Treatment: Inpatient hospital
The insurer denied the inpatient hospital stay
The denial is upheld in whole

The patient with an unremarkable past medical history who presented to the emergency department with acute right-sided vision loss. Reportedly, two days before her presentation she started to experience blurred vision in the right eye. Over the course of two days, symptoms became progressively worse, and this prompted the patient to come to the hospital.
The hospital stay was not medically necessary for this patient at the acute inpatient level of care.
There was no compelling clinical reason why the patient could not have safely and appropriately received evaluation and treatment at the lower level of care rather than admission to an inpatient level of care.
This patient presented to the hospital with complaints of acute onset of vision loss. However, the results of the physical examination and diagnostic studies that were performed in the hospital did not reveal evidence of any serious problem that would require care at the acute inpatient level.
The review of medical records did not demonstrate any evidence that the patient had any diagnostic studies or treatment performed during this very short period of hospitalization that would require admission at the acute inpatient level of care.
Some cases of vision loss related to eye pathology would require intervention at the acute inpatient level of care. There was no intervention including administration of medications, therapeutic procedures, or surgeries done in this clinical case. The patient's hospital stay was short, and the patient received no treatment that would justify medical necessity for admission at the acute inpatient level of care.