Diagnosis: Headache
Treatment: Inpatient stay
The insurer denied the inpatient stay.
The health plan's determination is upheld.

The patient is a female with a past medical history significant for Bell's palsy who presented to the emergency department with complaints of headache, numbness, and weakness in the right upper extremity.
The patient stated that she was under severe stress recently. She described a right occipital headache that occurred the evening before her presentation.

The inpatient hospital stay was not medically necessary. This patient did not need admission at the acute inpatient level of care. The patient presented with symptoms that were suspicious for cerebrovascular accident (CVA) versus cervical radiculopathy. The imaging studies ruled out CVA. The cervical radiculopathy was really mild and the patient did not need any surgical intervention for this.
There was no evidence that the patient had significant or progressive weakness in the extremities that was severe enough to cause functional disability and justify admission at the acute inpatient level of care. There was no evidence of paralysis, spasticity, or dystonia. Taking into consideration all these facts, neither the severity of the patient's condition nor the complexity of the services provided justified admission at the acute inpatient level of care. A lower level of care was appropriate.