Fishbone: In US= $1000+, In New Zealand Priceless?

      Like most good stories involving urgent/emergency care, this one did involve alcohol....and fish.

Joel wrote earlier about our first fishing trip in the Bay.  (Yes, those are Joel's hands holding onto the rod, but dad and son are still ribbing each other about who actually "caught" the fish.)  Little did I know that the Kahawai pictured above would lead to my first encounter with the New Zealand Accident Compensation Corportation or ACC for short.  The process of ACC was a wonderful experience that  made me realize that alot of healthcare dollars in the US are wasted on processing medical claims, and not on the treatment.  

     The ACC is the branch of the government run healthcare that provides coverage for any accidental injury that is sustained by a person visiting or residing in New Zealand.  Imagine coverage for workman's comp, assault victim compensation, medical, automobile and personal property liability, disability and accidental death insurance and one's own stupidity all rolled into one!  It is funded from the goods and services tax (GST) that everyone starts paying upon arrival in the country.  I found the fact I had already paid into the system an amazing relief of injury related anxiety as I sought out my own treatment.

     Back to fishing:  The alcohol involved was a very fine Marsden Winery (Kerikeri) Pinot Gris.  The fishbone was from the freshly barbecued Kahawai that we were enjoying during our trip to Urupukapuka Island.  I had just taken a bite of fish and chased it with a sip of wine, when I felt the jab of a fishbone in the back of my throat.  Like many a good holiday maker whom I have met over the years, I took the next most logical step....I drank some more wine!  To no avail, as I continued to feel a sharp but tolerable stab in the back of my throat during the rest of our meal.

      Later that Sunday evening after returning home, I gained more empathy for the daily perils of a bulimic while failing miserably at retrieving the bone.  I did get some good practice at my manual intubation technique by inserting my fingers all the way to my epiglottis.  Yet the bone remained lodged in my vallecula despite my attempts.  

     At this time, I was unfamiliar with the benefits of the ACC and how it could apply to my injury.  So it was with some trepidation on Monday, that I approached my work colleague, Dr. Taco and asked if he could visualize the bone.  My trepidation has been trained into me during my years of practice in the US.  Many a time, I have seen holiday makers whose injury pain and anxiety is worsened by the reality of a sudden pile of unexpected medical bills.  Even if they are well insured, they will spend the next several months sorting through medical bills and figuring out how and when to pay them.  Since my upper airway had been operated on within the past year, I was wondering how our US purchased travel insurance would apply their preexisting condition clause to my care.  Maybe I was a bit neurotic about the preexisting condition clause.  I once had to help defend a patients claim for surgical removal of a sixteen penny construction nail accidentally fired into his knee by confirming it was not due to a preexisting condition.  So I hope my neurosis was not unfounded.  

     We lacked the necessary medical equipment in our office to properly examine my throat, so Taco quickly arranged an appointment for me with an ENT consultant in Whangarei the next day.  On Tuesday, after finishing work, I made the one hour drive to Dr. Sheddy's (honorary member of the physician all name team, if you say it fast with a NZ/Indian/English accent) office.  Mentally I ran over the numbers I was probably more familiar with in the US.  Car travel one hour $30, ENT office consult fee $250, procedure fee for foriegn body removal $800, etc.  I mindfully patted by wallet to assure my Visa card would be there.  

     After filling out the small 4 x 6 notecard of my pertinent information (name, address, phone, email, referring doctor...that was it, and no identification check) I was allowed to wait for Dr. Sheddy.   Twenty minutes later I was in his chair, nasopharyngoscope insterted, tongue numb, and forceps grasping the fishbone.  Relief and appreciation for another physician's skills soon followed .  The offending trophy is pictured below. 

         

       I walked back to the reception desk, Visa card at the ready.   A pleasant smile from his receptionist, a statement of "No payment needed, it is covered under ACC".  A "Thank you"  and a dumbfounded look from me and I was on the way back home.  One week later I received a single page letter from the ACC stating my procedure was covered and payment was made to Dr. Sheddy. 
      Having just made our payment to St. Charles Hospital in Bend for the blood work that Kim and I had done for immigration  medical 3 months ago, I could not have had a more blatent example of a difference in administrative costs.  Kim and I had that blood work done in February.  It required a ream of paperwork to be filled out, even though I had been a patient at the same facility within the past year.  HIPPA paperwork, insurance verification, photocopies of our driver's license, and on and on.  Then once the blood work was completed, four seperate mail pieces for each of us between the hospital, us and our insurance company.  Finally after all of the insurance company "adjustments" we were left with our final bill.
      Hmm, a 4 x 6 notecard vs. eight sheets of legal mumbojumbo documents.  Immediate payment vs. adjustment and medical review by an insurance company.  One letter from the ACC stating payment was made vs.  4 letters with a final verdict that we needed to make the entire adusted payment to the hospital because we have a high deductible and the blood tests were not medically indicated?  No additional burden after my relief of pain vs. months of confusing bills and final additional financial burden.  Both processes are spending healthcare dollars, which is more appropriate?
    So as I contemplate these things, and look at my receipt from a recent dining experience, I smile happily knowing that the 12.5% GST is serving its purpose.  I might never know what kind of devious bones may have been lurking in that butter chicken we enjoyed!