Wednesday, February 23, 2011

Bell's Palsy

I'd never heard of it until the advice nurse at Kaiser mentioned it to J when he called on Monday. J had come down with an infection--chills, lethargy etc.--on Sunday. On Monday he couldn't brush his teeth properly. The right corner of his mouth was visibly lower than the left. He'd lost all his wrinkles, but only on the right side.

We were frightened. I was thinking, in my usual positive way, brain tumor, stroke. J called Kaiser in the morning. We had a phone consultation with the doctor in the afternoon. She decided that J should come for an in-person exam. We went. I stayed in the waiting room. It felt like hours. I imagined. It wasn't good. We'd spent some time on the Internet, the source of panic for all hypochondriacs, and decided that it probably was Bell's Palsy, but also noted that even doctors sometimes have trouble making a proper diagnosis. This is particularly true with stroke, where the symptoms come on suddenly, rather than a brain tumor, where the paralysis is usually, although not always, more gradual.

J finally emerged from the dark regions with the Bell's Palsy hand-out and two prescriptions. We headed off to the pharmacy, which reminded us that it was good to order regular prescriptions online and have them shipped by mail. We were relieved--and exhausted.

But to got me to thinking about health insurance, and what would happen to someone with the same symptoms who didn't have any. This isn't one of those things where you wait a few days to see if it goes away. A stroke requires immediate treatment to limit the damage, and Bell's Palsy sometimes doesn't completely resolve for several months. Our uninsured patient doesn't have many options, particularly on a holiday. (Yeah, these things always happen on holiday weekends, never on weekdays during normal business hours.) There's always the emergency room, but that's a really long wait and a large bill. Maybe our uninsured patient could receive care at an "urgent care" center, cheaper than the emergency room, but not without cost. And were I a doctor at an urgent care center, I'd probably be nervous about diagnosing Bell's Palsy and sending the patient home. It's most likely Bell's Palsy, as 75% of facial paralysis is, but it would be a potentially very expensive mistake if it turned out to be a stroke or, less likely, a tumor.

Could it be that the cost of J's care was actually cheaper than it would have been for an uninsured patient in the emergency room, as a simple diagnosis there is far more expensive than our trip to the doctor? Sure, it would have been cheaper to do nothing, and Bell's Palsy usually goes away without any treatment at all. But I wouldn't want to put anyone through the stress of not knowing and having to wait to see if anything worse happened.

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