Holly asks:
Got a question. Ok....let me try to make this simple. Charlie sees a doctor for some dizzy spells about a month prior to his accident, but doesn't go for further tests. He needs orthopedic surgery for broken bones after the accident. Would they do the surgery?
Jordyn: I don’t see this as a big reason NOT to do the surgery.
Dizzy spells are pretty non-specific meaning LOTS of things benign (like I have
extra fluid in one ear) to major (I have a brain tumor) can cause this. Most
often times it is something very benign and transitory.
Holly: And if he hit his head when his
truck rolled over, would he HAVE to have a head injury?
Jordyn: No, he wouldn’t have to have a head injury in the sense
that he wouldn’t have to have concussion. He likely would have some bruising
and pain at the site of impact but head injury is denoted more by global
headache (my whole head hurts and not just the bump), loss of consciousness,
nausea/vomiting, confusion, and perhaps amnesia progressing to more serious things
if you choose.
Holly: I'm setting up a scenario where the
insurance wants to deny coverage because of a pre-existing condition. (the
dizzy spells maybe caused a stroke, or so they determine.)
Jordyn: I don’t think a complaint of dizzy spells would be enough
for this. It’s not really a pre-existing condition. A pre-existing condition
has to be an actual medical diagnosis and dizziness is a symptom—something only
the patient can tell us they experience. A symptom is not something we can
measure. So, if he had a diagnosis of TIAs or Transient Ischemic Attacks and
one of his symptoms was dizziness then this might be more believable.
Holly: Which gives me a new question. Can
you prove a stroke has happened? Or a mini stroke.
Jordyn: Yes, strokes (new and old) can appear on certain imaging
tests. MRI is more specific for old and new brain injuries caused by stroke.
I believe they should go ahead and to the surgery. I would imagine everyone has dizzy spells at some point in their life. I also believe they should always do an MRI after a bad auto accident.
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