Diagnosis: Cardiac/Circulatory Problems - Chest Pain
Treatment: Inpatient hospital stay
The health plan denied the inpatient hospital stay as not medically necessary.
The health plan's determination is upheld.

The patient is a female. No actual medical records were provided for review. Per an appeal letter submitted by the hospital, this patient presented to the emergency department (ED) complaining of chest pain. Her medical history was remarkable for hypertension, hyperlipidemia, and breast cancer. Her electrocardiogram (EKG) was normal. She was treated with aspirin, a statin, and a beta-adrenergic blocker. Myocardial perfusion imaging showed no evidence of ischemia, and the patient was discharged.

At issue is the medical necessity of the inpatient admission.

The health plan's determination of medical necessity is upheld.

No medical records were provided for review. In the absence of medical records, it cannot be determined if an inpatient level of care was medically necessary.