Diagnosis: Asthma.
Treatment: Inpatient admission.
The insurer denied the inpatient admission.
The denial is overturned.

The patient is a male with severe persistent asthma. He presented to emergency room with asthma exacerbation. The patient was treated with frequent nebulizer treatment as well as IV (intravenous) steroids without much improvement. The patient was admitted to acute inpatient level of care and continued to receive IV (intravenous) steroids, nebulization treatments and was seen by pulmonary specialist. The patient had difficult to treat symptoms of asthma and had prolonged hospitalization.

This entire admission was denied by the health plan due to lack of medical necessity. This denial is being appealed.

The health plan did not act reasonably, with sound medical judgment, and in the best interest of the patient.
The patient had severe asthma exacerbation, and had failed outpatient treatment as well as emergency room treatment. The patient was started on IV (intravenous) steroids but continued to have symptoms despite 24 hours of care, and the IV (intravenous) steroids were increased after pulmonary consultation. The patient continued to have SOB (shortness of breath) and wheezing on higher doses of IV (intravenous) steroids and needed prolonged hospitalization. The patient has history of severe persistent asthma with previous intubation and mechanical ventilation. Since patient had slow response to IV (intravenous) steroids, the prolonged hospitalization is medically necessary.