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

The patient is a male who presented to the emergency department (ED) complaining of chest pain and dyspnea. He had been seen earlier that day complaining of generalized weakness and had been discharged. He had also been hospitalized and discharged earlier for complaints of palpitations.

Based on the documentation provided an inpatient hospital admission was not medically necessary.
This man presented with symptoms that were thought to be suspicious for acute coronary syndrome (ACS). Accordingly, observation until ACS could be ruled out was a reasonable approach. However, he was hemodynamically stable, with normal cardiac biomarkers, and a normal electrocardiogram. He did not require acute intervention, intensive monitoring or infusion of intravenous cardioactive medications. The care this patient received did not require an inpatient admission and could have been provided at a lower level of care. This approach has been shown to be both safe and effective and is in accordance with current guidelines.