Digestive System/Gastrointestinal
Inpatient Hospital

Diagnosis: Small Bowel Obstruction
Treatment: Inpatient Hospital Admission
The insurer denied the inpatient hospital admission.
The health plan's determination is upheld.

The patient is a male with a history of colon cancer status/post (s/p) partial resection and multiple abdominal procedures who presented with nausea and vomiting.

The health plan, in its determination of medical necessity, did act reasonably, with sound medical judgment and in the best interest of the patient.

The requested health service/treatment of an inpatient hospital admission was not medically necessary. The computed tomography (CT) CT was with findings of a small bowel obstruction (SBO). The patient was admitted for bowel rest, intravenous fluids (IVF) IVF and he was treated with conservative management with bowel decompression with a nasogastric (NGT). The patient began to pass flatus and was transitioned to a clear liquid and regular diet. The patient was able to be managed at an alternate level of care with supportive care and resolution of his small bowel obstruction.

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