Diagnosis: fever/diarrhea.
Treatment: inpatient stay.
The insurer denied the inpatient stay.
The health plan's determination is upheld.

This is the case of a young male who presented to the emergency department (ED) with fever and diarrhea. Symptoms began 5 days prior. There was some associated vomiting at symptom onset.
The ED vitals were T (temperature)101.1oF (Fahrenheit) rectal, heart rate (HR) 106, respiratory rate (RR) 26, and O2 (oxygen) saturation 97% on room air. The exam was unremarkable. The patient was given Zofran and oral fluids which were not tolerated. Therefore, he was started on intravenous fluids (IVF). Labs showed COVID and Adenovirus positive, bicarb=16, and urine with specific gravity (SG)=1.032. Due to the continued refusal of oral intake, the patient was admitted to the hospital for overnight IV(intravenous)hydration.

The inpatient hospital admission was not medically necessary. A lower level of care was appropriate. This patient presented with gastroenteritis and dehydration. Vital signs showed an initial fever but were otherwise stable. Labs supported mild to moderate dehydration. The ED notes indicate initial disposition to home; however, the patient was admitted due to refusal to take fluids orally. Given the patient's well appearance, stable vital signs, and uncomplicated medical history, this case could have been handled at a lower level of care.