ALT Diagnosis: pulmonary embolism without acute cor pulmonale dates: 11/29-11/30 the clinical reason for our determination is: you were admitted to the hospital on 11/29/2024. the reason is blood clot to lung. We read the medical records given to us. We read the guidelines for a hospital stay. This stay does not meet the guidelines. You did not have to be admitted as an inpatient in the hospital for this care. The reason is you were watched closely in the hospital . You were stable. You had tests that did not show any problems that needed inpatient only treatment. The records showed your blood pressure was not too low. You did not need a breathing machine. you could have gotten the care you needed without being admitted inpatient at the hospital. the hospital inpateint admission is not covered. We let the hospital know that this is not covered.