Patients admitted to the hospital with chest pain and other significant findings in the ER can still be denied for inpatient stay by insurance companies. One case involving a patient with severe stenosis of the right coronary artery and another critical lesion shows how an initial denial by the insurance company can be overturned after […]
Case Study: Chest Pain, Unstable Angina P2P Reveals Intricate Case Read More »
Healthcare insurance companies often deny inpatient hospital stays if the information provided does not show intensity of services significant enough to need inpatient care. If the patient’s care is more intense than the medical record implies a Peer-to-Peer discussion can provide more critical information to the insurance company. CLINICAL SUMMARY: Acute Diverticulitis A 69-year-old female
Case Study: Acute Diverticulitis Stay Denied Read More »
A recently denied inpatient hospital admission for asthma exacerbation and wound infection was overturned when the insurance company was made aware of additional symptoms that doctors deemed high risk and worthy of a higher level of care. Clinical information sent by the hospital to the insurance company did not show the need for the extra level
Case Study: Post C-section Wound Infection and Asthma Exacerbation Denial Overturned Read More »
A recent case reviewed by AppriseMD showed a good example of how a case that on the surface appears inpatient appropriate can still be denied by the insurance company and overturned on peer-to-peer (P2P). Oftentimes a level-headed conversation with the insurance company will lead to the correct outcome. The case involved a drug overdose and
Case Study: Denied Inpatient Stay Due to Suicidal Ideation and Drug Overdose Overturned Read More »
CLINICAL SUMMARY This case involved a 74-year-old patient who presented with chills and a temperature of 103°F. The patient had a past history of hypertension, arthritis, and right total shoulder replacement in January 2021. Chest x-ray showed coarse perihilar and interstitial markings, likely viral or reactive. A CTA chest was negative for pulmonary embolism or
Case Study: Sepsis Presents Challenging Denial Read More »
CLINICAL SUMMARY This case involved an 83-year-old female patient with a known history of chronic COPD on 4L supplemental oxygen via nasal cannula, DVT, gout, multiple falls, hypertension, and anxiety. She arrived in the emergency department with complaints of shortness of breath that had gotten worse over the previous 24 to 48 hours, especially on
Case Study: COPD Needing Inpatient Level of Care Read More »
CLINICAL SUMMARY This case study involves a 54-year-old female patient with a past medical history of type I diabetes, diabetic gastroparesis, nephrolithiasis, hypothyroidism, hypertension, and traumatic brain injury. She arrived in the ER out of concern for diabetic ketoacidosis (DKA). The patient was hospitalized for DKA one month before this admission. She had been sick with
Case Study: Diabetes Patient Short Stay Read More »
CLINICAL SUMMARY: Bilateral Pneumonia A 23-year-old nonverbal female patient arrived in the emergency department with her parents who said she had a fever and heavy breathing since the morning. The patient’s medical history included Lennox-Gastaut Syndrome, severe mental retardation, seizure disorder, recurrent aspirations, recurrent pneumonia and vagal nerve stimulator. Her parents said she had been
Case Study: Bilateral Pneumonia Read More »
Chest pain is one of the most common ER diagnoses. For those patients who require hospital admission, getting the admission status correct and paid by the insurance company can be tricky. One such case involved a patient who arrived in the ER with chest pain presumed due to unstable angina (TIMI 3). The patient was
Case Study: Chest Pain, Non-cardiac can be Difficult to get Admission Status Correct Read More »