Case Study

doctor holding stethoscope

Case Study: Alcohol Withdrawal Inpatient Denial Overturned Based on Care Required

Alcohol withdrawal and a positive COVID infection resulted in an inpatient hospital stay for one patient; however, the insurance company denied the short stay. A detailed peer-to-peer discussion of this case with the insurance company overturned the denial based on the acute symptoms and the medical and supportive care required. CLINICAL SUMMARY: Alcohol Withdrawal A […]

Case Study: Alcohol Withdrawal Inpatient Denial Overturned Based on Care Required Read More »

P2P Review for Multiple Sclerosis Case

Case Study: Multiple Sclerosis Inpatient Stay Denial Upheld

Determining level of care as a live case review can be difficult when doctors are still waiting on imaging and deciding upon treatment plans. One such live case review involved a patient with multiple sclerosis as detailed here, which AppriseMD recommended for inpatient level of care. The insurance company denied the inpatient stay. After completing

Case Study: Multiple Sclerosis Inpatient Stay Denial Upheld Read More »

EKG P2P Review for Angina Case

Case Study: Chest Pain, Unstable Angina P2P Reveals Intricate Case

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 »

Case Study: Acute Diverticulitis Stay Denied

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 »

Peer To Peer Reviews for Hospital Cases

Case Study: Post C-section Wound Infection and Asthma Exacerbation Denial Overturned

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 »

Review for Denied Inpatient Hospital Stays

Case Study: Denied Inpatient Stay Due to Suicidal Ideation and Drug Overdose Overturned

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 »

Short Stay Reviews shown through diabetes patient case study

Case Study: Diabetes Patient Short Stay

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 »

P2P Review for Denied Inpatient Stay

Case Study: Bilateral Pneumonia

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 »

Scroll to Top