Case Study

Review for Denied Inpatient Hospital Stays

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

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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 […]

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Case Study bilaterial pneumonia denial overturned

Case Study: Bilateral Pneumonia

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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

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CS-chest-pain-non-cardiac denial overturned

Case Study: Chest Pain, Non-cardiac Can be Difficult to Get Admission Status Correct

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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

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