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201904-116505
2019
United Healthcare Plan of New York
HMO
Central Nervous System/ Neuromuscular Disorder
Inpatient Hospital
Medical necessity
Upheld
Case Summary
This is a patient with past medical history of CVA, craniotomy, seizures, diabetes, chronic cholecystitis, and status post cholecystectomy who presented with weakness and decreased oral intake. The patient was treated with IV fluids and potassium. A neurology consult was done. The health plan's determination was upheld. While the patient needed further care, it could have safely and effectively been provided at a lower level.
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