Summary of Benefits and Coverage

In June, a healthy 25 year old male forcibly twists his left foot. He is in severe pain and cannot
get up or walk on his own. He is taken by ambulance to the emergency department at a nearby
hospital. A hospital physician who examines him applies the Ottawa Ankle Rules, consistent
with clinical guidelines, and finds that he has bone tenderness and cannot ambulate his foot. He
reports that he has never had ankle sprains or fractures before. The physician orders an x-ray
and diagnoses him with a clinically significant (over 3 mm in breadth) fracture of his fifth
metatarsal. The bone is adequately aligned. He is released from the hospital the same day with
pain medication, crutches, and a splint, which he wears for the next two weeks. He follows up
with an orthopedic specialist twice. On the first visit, the specialist removes the splint, and
places a weight-bearing cast on the ankle. On the second visit, six weeks later, the specialist
takes another x-ray, removes the cast, and orders physical therapy sessions to restore mobility
and regain strength.
DISCLAIMER: This narrative and the accompanying benefit scenario illustrate care for a
hypothetical patient receiving treatment for an ankle fracture. The care, and cost of care, will
vary for each patient. No portion of this narrative or the accompanying benefit scenario should
be construed as recommendations for care, or cost of care, by the United States Government.