Diagnosis: Asthma.
Treatment: Inpatient Hospital Admission.

The insurer denied the Inpatient Hospital Admission. The denial is upheld.

The patient is an adult female with asthma. She presented to the ER (emergency room) with shortness of breath. The patient was found to be in asthma exacerbation. The patient received duonebs, IV (intravenous) steroids, and IV (intravenous) magnesium sulfate. The patient was admitted to acute inpatient level of care for further management. The patient was started on IV (intravenous) steroids and duonebs. The acute inpatient admission was denied coverage by the health plan due to lack of medical necessity. This denial is being appealed.

The Inpatient Hospital Admission was not medically necessary.

The patient had asthma exacerbation. The patient improved with ER (emergency room) care and was hemodynamically stable and was not in any respiratory distress. The patient did not need any supplemental oxygen. Given the patient's signs and symptoms due to asthma exacerbation improved significantly with ER (emergency room) care, the patient's treatment course would have been expected to be safe and effective at a lower level of care. The treatment provided to this patient was reasonably expected to be provided but did not require an acute inpatient level of care.