Diagnosis: Atrial flutter.
Treatment: Full hospital admission.
The insurer denied the full hospital admission.
The health plan's determination is overturned.

This woman presented to the emergency department (ED) complaining of fever, chills, cough, dyspnea, chest pain, headache and rigors. Her medical history was remarkable for paroxysmal atrial fibrillation, coronary artery disease, percutaneous coronary intervention, peripheral arterial disease, left below knee amputation, heart failure with preserved ejection fraction, diabetes, asthma, anemia, mesenteric ischemia, chronic myelogenous leukemia and obesity.

The inpatient hospital admission was medically necessary.
This woman, with multiple medical problems, was admitted to the hospital with COVID-19 (coronavirus disease) infection and atrial flutter with a rapid ventricular rate. She developed a type 2 myocardial infarction (MI) from demand ischemia. Her hospital course was complicated by persistent, worsening anemia and acute kidney injury. During that time period in question, the patient required repeated red blood cell transfusions for decreasing hematocrit. Given her recent type 2 MI, significant anemia placed her at risk for further myocardial injury. Thus, careful and frequent monitoring of her hemoglobin with transfusions as needed was required. The patient also developed abdominal pain with marked leukocytosis. Given her history of mesenteric ischemia, as well as her immunosuppressed state due to her chronic myelogenous leukemia, this was a very concerning situation with the potential for catastrophic outcomes. This patient was at substantial risk for major adverse events. She required frequent monitoring of her clinical status and various laboratory studies with the ability to intervene emergently, if needed. This could only have been accomplished safely in an inpatient setting.