What do you do when you don't know what to do?

Things have been a little crazy around here lately. Lately, it seems like it is always a little crazy around here. Still, it has been a little MORE crazy than usual within the last couple of weeks. Truth is, I haven't been feeling well for some time now - I mean, I'm talking months. My symptoms are identical to a situation I had three years ago, when I had surgery to have a very large stone removed from my bladder. At the time, my urologist said that it was the largest stone he had ever seen in over 20 years as a urologist (hey - I win!). The stone was removed, but since I didn't really care for the doctor, I didn't do the follow-up to see what caused the stone or what treatments might be needed to prevent the same from happening again.

Fast forward to the present day. Back in January, I knew that I wasn't feeling well, but since my symptoms were identical to the last stone, I knew what I was in for, and I could tolerate being uncomfortable for a little while - and I didn't really fancy going back to the urologist, I suffered quietly, as best I could. Besides, I didn't want to miss my trip to Texas or the spring travel season for work while I was recuperating from surgery. In retrospect, and in no small part based on how I feel right now, I do realize that was utterly stupid.

When I got back to Florida after spring travel, I started to see a doctor and get the wheels in motion to get this stone out of me. Unfortunately, I learned that doctors are not really willing to rely on my own diagnosis and just schedule me for a surgery requiring multiple incisions. Instead, I have endured a battery of tests - the result of which is that they have found a mass in my bladder that is about 6.5 cm. Confident that this is the stone to which I referred, I again requested that they slice me open and remove the stone so that I could get on with the business of enojoying my summer. My new urologist, before slicing, insisted on doing a cystoscopy (a procedure that no man should ever volunteer for!) and getting a "look" at the mass.

Upon viewing this mass, the doctor informed me, in no uncertain terms, that I have some form of bladder cancer. Knowing that this is almost impossible, I informed the doctor that he was clearly incorrect - merely viewing my (abnormally large sized) stone as something else. Again, he questioned my ability to self-diagnose. To that end, he claimed to be confident that this is not a stone, but rather some form of cancer.

As a 35 year-old, non-smoker who is not exposed to industrial chemicals, it wouldn't seem as though I am in any of the risk categories for this type of cancer. But, the urologist doesn't see it that way. This means that I have to go in for another scope tomorrow (Thursday) to find out exactly what is going on in my bladder. I estimate the urologist's chances of being right at about 30%. However, since hearing this news about 10 days ago - I have been a little freaked out. OK...I started out a LOT freaked out, but I am much better now.

Up until now, this blog has been at least semi-anonymous. I really couldn't figure out how to tell all of the people that I thought should know, so I went for the completely impersonal approach. I deal with talking about myself best that way. I also did some inner battle with whether or not to say anything until I knew something more concrete. So - I almost wussed out on saying anything until hours before I am supposed to go in for surgery. Nothing like pulling the pin out of the grenade, tossing it in the room and then taking off running.

Let me be clear about a few things - in the last week and change, I have done a lot of reading about cancer - this cancer (that I may or may not have), specifically. I have learned even in the worst case scenario, this is not a death sentence. That's the good news; the bad news is that there is a serious likelihood of recurrence somewhere down the road. While death is not likely, some of the things that I may have to live with aren't all that appealing, either. For instance, at 35, I am not sure that I am looking forward to a lifetime of "touching, holding, cuddling, and caressing." I am pretty sure that I will not take the news very well if I am told than I need a radical cystectomy. The thought of having to drain my fake bladder every few hours manually is more than I can stand to think about. I have mentioned that I really do still think that this is just a stone, right?

I have contacted some of my favorite bloggers and asked them to post about the personal finance angle of learning potentially life-altering news. JD from Get Rich Slowly is going to feature this story on his blog in the next day or so, and hopefully, there will be a number of people who can offer up some advice - because I admit to being baffled with a lot of this stuff. And, as independent a guy as I am, going through this alone has me just a touch petrified. Hopefully, other bloggers will pick up on the discussion, as I feel this topic (personal finance as related to possible health issues) is somewhat underrepresented. I will post a follow-up as soon as I can.

Also, I ask that you try to take just a few things away from this post. The first is that I am not looking for sympathy (heck, I don't even think the cancer diagnosis is true yet!), and, even if it is true, I don't think I am going to die. I am not looking for an outpouring of support and prayer (though, I am not going to kick anyone away with a better pipeline to the "Big Guy" than myself). I am fortunate that I have decent health insurance and more sick leave than I ever thought I could use. I hope that any friend of mine who reads this takes away the idea that if your body is telling you something is wrong - and you know it - go to the doctor, go directly to the doctor, do not pass 'Go!', do not collect $200. I know that I have learned my lesson with my own version of "Scared Straight!"

This might be a good time for me to make a sales pitch for you to sign up for the email updates using the block to the upper-right. You won't get spam - and lord knows I don't post all that frequently, but you will get an ad-free, black-on-white, basic formatted HTML version of any updates from this blog only (your name won't be sold or used for any other unsavory things).

This story is updated here.

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Smart Move 2006: Healthcare Reimbursement Account

This is the time of year when I spend an inordinate amount of time reviewing obsessing over what went right and what went wrong in the previous year. This is my own way of planning what actions to take to ensure more right things and fewer wrong things in the current year.

I think one of the smartest things that I did happened almost by accident. My employer, like many others, offers a number of medical insurance options. To boil them down to their simplest parts, each plan offers to cover a percentage of medical expenses, descending in value commensurate with the required payment assumed by the employee - 90% (the most expensive plan); 80%; 70%; and "risk-reward," which also covers 80%, but has higher deductibles, annual maximums, and co-pays. The previous year, I had the 70% coverage, which cost me $35.78 every two weeks. The cost for the same coverage for 2006 increased to $37.57, which I thought was pretty reasonable. It seems that I have heard nightmare stories from co-workers, who need to insure their whole families, about double-digit percentage increases in health care coverage.

After I signed up, when I read through the plan coverage, I found that I was eligible for a new benefit - the Healthcare Reimbursement Account (HRA). This new account was funded exclusively by my employer, to the tune of $60/month, and the money could be used by me in a manner similar to that of a medical Flexible Spending Account. In effect, I would be paying about $80/month out of my pocket in medical insurance, and getting $60 of that back to be used to any incurred medical expenses. Some common examples of what the money could be hospital services; physician, dental, vision and chiropractic services; eyeglasses, contact lenses and saline solution; co-pays and deductibles; prescription drugs (including co-pays); home health care; durable medical equipment; and drug and alcohol rehabilitation - almost everything except elective cosmetic surgery. Note: If I had additional dependents on my health plan, my monthly HRA reimbursement would be $120/month; the "risk/reward" plan comes with a $90 monthly HRA payment for singles, and $180/month for families. In addition, the money that remains unused each month earns interest while it sits in my account. The money rolls over from year to year (unlike a medical FSA) and becomes fully vested and portable after three years of participation in this plan, otherwise you would need to spend all of the money prior to terminating employment.

I am fortunate in that I don't spend too much time (translation: don't spend much money!) with doctors. One of the reasons why the 70% plan is a viable option for me is because I can assume some additional risk and hope that I can continue to live a relatively healthy life. I was choosing the 70% option anyway - so, this new benefit didn't really encourage me to assume this additional risk. It was literally, an added bonus, for me.

It is incredibly easy to use. I was sent a debit card last year and I use it just like I would use any other debit or credit card at my doctor's office or pharmacy, etc. I used it at the doctor's office flawlessly - my $20 co-pay was immediately credited, and deducted from my account. I also picked up a prescription and some over-the-counter medication at the drug store. For that transaction, I had to send in a copy of the receipt (so they could be sure that I didn't purchase Twinkies, I guess). I sent in a fax and received a letter in the mail a couple of days later approving the charge. Easy as pie.

Since I didn't bother to crunch any numbers before making my selection last year (I was just really re-upping with what I had), I need to sit down and do that this year to compare the relative value in downsizing my plan to the "risk/reward." It would save me about $8 per paycheck (nothing substantial), but also give me an additional $30/month in HRA money.

I don't think that my employer did a particularly good job of educating people about the availability of this additional benefit - and that it would be paid by them, into an account, for the empoyee. Clearly, this is designed to encourage the insured to assume more risk, as that would be less expensive for the insurance companies. You would think that employers would WANT their employees to sign-up for something that would save them money in health care costs in the long-term. I suspect that when it comes time for choosing plans this year, their will be a better effort to educate people on this plan.

Assuming I can keep up my relative health, my biggest question will be on what to spend the money? I am considering saving for LASIK surgery, but treating this like "found money" in the meantime.

**Welcome Carnival of Personal Finance readers! If this is your first visit, you may want to stop by the Introduction page. That will give you a brief overview of what to expect to see elsewhere on this site. This is not a single-focus blog, so you will find posts here on more topics than just recipes and food. I do travel a lot for business, so I have quite a few posts (and pictures) of where I have been and the food I have discovered on the road. My finances are equally as important to me, and my work in college admissions allows for some unique perspective on the college search and financial aid.

I am glad you stopped by, and hope that you might poke back again sometime soon. The newest posts can be found by clicking on the "Home" tab at the top of the page.

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