Diagnosis: Ovarian Cyst
Treatment: Inpatient Hospital Stay
The insurer denied the Inpatient Hospital Stay
The determination is upheld.


The patient had an ovarian cyst and underwent a robotic assisted laparoscopic right salpingo-oophorectomy, requiring conversion to a laparotomy. The patient did not have a fever and her vital signs were stable. She tolerated oral intake and oral medications. The patient was discharged to home. At issue is the medical necessity of an inpatient stay. The requested health service/treatment of inpatient stay was not medically necessary for this patient. The patient was afebrile, with stable vital signs, she had a non focal exam and she was able to ambulate, void and take oral medications, as well as an oral diet. The patient did not have any conditions that required an inpatient level of care. This is consistent with peer-reviewed literature, consistent with standard of care and supported by professional organizations.