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Complications swelling presents during surgery?

Hi all,

I was a patient who suffered a fractured clavicle from a bike trauma requiring surgery for an open reduction internal fixation (plate and screws). My surgery was originally scheduled the day after my accident, but then pushed back a day due to swelling based on the doctor's decision. Surgery went smoothly and I'm healing fine.

However, my insurance is currently viewing that delay as a medically unexplained delay and denying coverage for that one day inpatient service. I was wondering if anyone could provide any insight into the complications of edema specifically during ORIF in orthopedic surgery and especially for a shoulder surgery?

Any information that might come from a journal or textbook would also be greatly appreciated as I plan on filing for an appeal.

Thank you all in advance.
3 Responses
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7721494 tn?1431627964
Harder environment to work in. No greater risk, just stuff in the way.
Helpful - 0
Avatar universal
I agree and have already asked him (the surgeon) to provide a letter / statement for me.

But I was also just curious as well. I had a previous orthopedic surgery for a fractured fibula as well (this time as an outpatient), and was close to having the surgery pushed back due to inflammation.

I can find a lot of information about pre- and post- surgical inflammation, but nothing that just seems to discuss the challenges during surgery. Such as is it just harder environment to work/navigate in? Higher risks of infection post-surgery? Or etc.
Helpful - 0
7721494 tn?1431627964
Not an attorney but not sure this is the right way to go. Sometimes surgery has to be done, in spite of acute inflammation.

This was a medical decision made by your physician. He was there, and your insurance company was not. Shouldn't this be the argument around which you base your appeal?
Helpful - 0
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