We’re sitting in the waiting room at the hospital where my husband has his knee surgery last month, waiting to see the doctor for his follow up appointment.  We’re very optimistic that he’s going to get some additional mobility clearance, and hopefully we’ll be able to do the rest of his treatments at the physical therapy clinic right near our home.

I packed a lunch for us, which we ate in the car before we came in for the appointment.  But we’ve decided that we’re going to go out to eat dinner after the appointment is over, as a little treat.  I swapped shifts with a friend at the library in order to avoid taking any vacation time for today, and we’ve both been working at least six days a week for quite some time now.  So we decided that a dinner out would be a nice bonus.  But knowing us I’m sure we’ll find somewhere where we can keep the bill under $35 or so.

A friend at the library who has finished having babies gave me some stuff yesterday – we got a baby bathtub and a little play mat with criss-cross arches that go over it with toys hanging off them.  It seems that people are more than happy to give away baby stuff that they aren’t using anymore, and we’re thrilled to have it.  I don’t care at all whether our baby stuff is new or used, or whether it matches anything else in our house.  And my list of things we “need” for our baby is a whole lot shorter than Babies R Us would recommend.  But it’s made the financial aspects of getting ready for the baby a whole lot easier than they would have been if we wanted all the latest and greatest stuff.

Mapgirl has just had laser eye surgery, and she wrote a really informative article about the experience and the cost.  My husband has been pondering LASIK for years.  He can’t see much of anything without glasses, so I can understand his desire to have eyes that just work.  I have glasses but I only really need them to drive at night or to watch subtitled movies.  I am freaked out by the idea of someone cutting his eye with a laser, but I suppose that’s because I tend to be paranoid about things like that. 

We’ve tossed around the idea of getting his eyes fixed, but we’ve never looked into the actual cost or what’s involved.  Now that we’re out of debt and doing ok financially, we might start saving towards LASIK.  We would use our HSA, and we would only get the procedure done after we had all the money saved in the HSA first.

I was surprised by the price tag in Mapgirl’s article.  I had thought that LASIK on both eyes would run about $2000 – $3000.  Guess not.  I found this site that shows national averages, and it looks like we’d be paying about $4200 – $4800 to get both of his eyes done.  Ouch.  That’s a lot of money.  We’re going to max out our HSA again this year ($5800), but once we pay our deductible for his knee surgery ($3000) and our midwife’s charges (another $3000), we’ll only have about $3700 left in the account at the end of 2008.  So it would be 2009 for sure before we had enough money built back up in that account to cover eye surgery. 

That will give us plenty of time to talk about it and figure out what we want to do.  I absolutely do not want him to go to some cut-rate place that offers LASIK for $500.  (the article I linked to above says those places have all sorts of hidden fees anyway, and you end up paying much more than they advertise).  These are eyes we’re talking about – we only get two, and they have to last a lifetime.  So I want to make sure that if we decide to go ahead with LASIK, we find the best doc around and don’t take price into consideration.  In order to feel comfortable taking nearly $5000 out of our HSA to pay for LASIK, I think I’d need to know that we had at least another $3000 remaining in the HSA, to cover our health insurance deductible in case an unexpected medical situation were to arise.  The HSA is our emergency medical fund, and with a $3000 deductible, I wouldn’t feel comfortable cleaning the whole account out to pay for eye surgery.  So maybe it will be 2010 before we can afford this…

After my husband’s knee surgery on Monday, the docs and physical therapists were going over all the things we need to do for the next few weeks to give him the best chance of a full recovery. One of the things they emphasized was ice, and their recommendation was an automatic icer. It’s basically a cooler with a pump inside it and two hoses that come out of it and plug into an insulated wrap that goes around the knee. Then there’s a cord that plugs the unit into a wall outlet and has a control to adjust the level of coldness. All we have to do is refill the ice as it melts, and keep it plugged in.

The other option was to use plain old ice packs. But the catch is that he’s supposed to be icing his knee pretty much constantly all day and all night. If we use ice packs, we have to take them on and off to make sure that we don’t ice for more than 20 minutes each hour (to avoid over cooling the area). But the automatic icer cycles on and off, so you can leave it on all day and it will maintain the right temperature.

In the hospital, they told us that they would bill the ice machine to our insurance, but that there was no guarantee that it would be covered, and that we would be responsible for the price if the insurance company doesn’t pay for it. They told us it runs $200 – $300, depending on what insurance network you have.

We decided to go for it. We took the icer and the hospital is billing the insurance company. We hope that they cover it, and we think there’s a good chance they will (and we’re brokers for that insurance company and sell a good number of policies for them every month, so we do have contacts there and a bit of leverage if we need to use it). But even if they don’t, we consider it $300 well spent. Every night, we’ve been able to just plug the icer in next to our bed and go to sleep, knowing that it will keep his knee cool all night. I get up after about 6 hours or so and add more ice, but that’s a whole lot better than taking an ice pack on and off every hour. If we didn’t have the automatic icer, his knee would probably not be getting iced nearly as well, despite our best intentions.

I suppose it would have been frugal to use ziplock bags of ice cubes and take them on and off all day for the next few weeks. But the results would probably not have been as good, especially at night. This is one of those times when the more expensive option ends up being the better value, both in convenience and in overall outcome. I’m glad we take the frugal option 95% of the time, because it makes it easier to take the more expensive option when it really matters.

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I’ve been reading raw food cookbooks for about the last two years, and I try to make sure that half the food we eat each day is raw.  We all know that we’re supposed to be eating leafy dark greens, and I’ve tried hard (especially since I’ve been pregnant) to make sure we eat at least a little every day.  But I would find myself struggling to figure out ways to prepare them. 

Then a few weeks ago, I got this book out of the library.  The author reiterates how important leafy dark greens are, and then she describes what seems to be the best way I’ve ever seen to incorporate them into our diets.  Green smoothies.  Every morning and evening now, I put a whole bunch of organic greens (spinach, chard, beet tops, kale – whatever I have) in my food processor with a little water and some frozen organic berries.  Then I let the food processor do its thing for about three minutes.  Viola!  Green smoothies that have dramatically increased our consumption of dark greens.  It doesn’t get much easier as far as food prep goes, and they’re surprisingly tasty – even my husband agrees. 

So I don’t have to think about how I’m going to add leafy greens to our meals anymore, and I haven’t eaten salad dressing in three weeks.  I do have to go to the store more often now, since I like using very fresh greens in my smoothies.  But I make sure that I go straight to the produce section, get my greens (whatever organic variety is on sale) and get out – no wandering the grocery store and picking up random things here and there.  Since I can walk to the grocery store from our house, it’s not inconvenient to shop for greens a few times a week.  If we lived out in the country, I would probably switch to frozen greens for my smoothies.

I’m already thinking about spring time when we can plant our little patch of chard out back and I’ll be able to make free smoothies all summer!

Yesterday, my husband went for his consultation with the knee doctor.  He had to drive 2.5 hours to get there (the doctor is considered one of the best in the world, but the only downfall is that it’s quite a drive.  But compared with all the people who fly to see him, we’re not doing so badly to have to drive a few hours).  He left the house at 6:30 am and got home at 8pm, so it was quite a day.  They did x-rays and an MRI, and have determined that they definitely need to do surgery on one knee, possibly on the other as well - lots of issues. 

When they did the MRI, they required payment upfront.  They hadn’t mentioned anything about that when he scheduled the appointment.  They had told him what kind of clothes to wear (shorts, with no metal in them) for the MRI, but nothing about payment up front.  They’re on our insurance network, and typically providers bill the insurance and then send the patient a bill a few weeks later for the deductible amount.  Our deductible is $3000, and the MRI cost about $1200 (our insurance company’s rate).  But this doctor’s office just ran the numbers right there, determined what portion the insurance would pay (zero, since we haven’t met the deductible yet), determined the insurance rate for the MRI, submitted it as an expense to our insurance so that it would get counted towards the deductible, and then asked for payment.  Good thing we always carry a credit card.  I’m a big fan of credit cards.  We have one personal card and one business card (plus the AmEx that we only use at Costco, so I’m not counting it).  We pay them off every month, so we don’t pay interest.  In this situation, we have the money to pay for the MRI, it’s in our HSA.  But to access that money, we have to call the HSA and have them initiate a balance transfer to our checking account.  The money shows up in the checking account in a few days. 

Since this doctor’s office had a bit of an unorthodox billing method (upfront payment from patients with insurance), we would have been in a pickle without a credit card.  As it is, my husband just put it on the card, and then today we’ll call the HSA and have the money transfered to our checking account.  Then when the credit card bill gets here, we’ll just pay it off. 

Having a credit card and still spending less than you earn takes discipline.  But it also offers a safety net in unforeseen situations.  I’d rather force myself to have discipline on a day to day basis with our card, and always know that it’s there in my wallet if I need it.