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Does a Managed Care Denial Equal Bad Medicine?
Does a managed care denial equal bad medicine?
A 76-year-old female with a history of diabetes, hypertension, and coronary artery disease presents with a warm, swollen, tender, left leg. On hospital day number 3, the patient is noted to be improved. She is afebrile, and the cellulitis area has decreased in size by 50%. She is tolerating a diet and is working with physical therapy. The patient’s managed care company sends a notification that as of this date, further inpatient care is no longer medically necessary and reimbursement is denied. Did the managed care company make an appropriate decision in the care of this patient?