How to spend less on health care

| December 12, 2008

Fuel isn’t the only staggering expense chomping at your income. Health care spending in America jumped 7 percent in 2007.

Fuel isn’t the only staggering expense chomping at your income. Health care spending in America jumped 7 percent in 2007 – twice the rate of inflation – to $2.3 trillion, according to preliminary figures from the nonprofit, nonpartisan National Coalition on Health Care. That’s $7,600 per person.

Small wonder that health is the third core reason why owner-operators fail, behind only poor truck maintenance and a lack of business skills. “A truck driver can find a way to pay a $3,000 bill. They can set up a payment plan,” says Dennis Carter, an insurance consultant with Adrian & Associates who works closely with trucking financial services company ATBS. “But a $30,000 bill will kick them off the road.”

For health care costs, as with fuel costs, truckers seem to have a bull’s-eye painted on their chests. They’re surefire targets for obesity and therefore sleep apnea, high blood pressure, diabetes, high cholesterol and heart disease, says Dr. John McElligott, medical director and CEO of Knoxville, Tenn.-based Professional Drivers Medical Depots. That’s because of the nature of the profession: long hours sitting behind the wheel, lack of exercise and the unhealthy nature of most foods available to on-the-go drivers. The Occupational Safety and Health Administration has put the average life expectancy of a trucker at 61, or 15 years less than the average American male.

Most over-the-road drivers rarely have the time even to see a family physician at home, much less a doctor while on the road, says McElligott. Most also lack the desire for a disciplined approach to diet and exercise.

Not so with owner-operator Juan Astudillo of Laredo, Texas, a truck driver for 12 years. He walks laps around his truck whenever it’s parked and opts for the rear of the parking lot to allow himself some more time on his feet. “I try to eat healthy,” he says, choosing salads when the option is available. He also stores nutritious food in his sleeper.

Richard Adam Jr. of New Hampshire, a company driver who hauls lumber regionally, gets home nightly and hits the gym equipment in his cellar. If truck stops had workout facilities, Adam says, “I can guarantee you I’d use them.”

Complicating this health picture for many owner-operators is inadequate health insurance coverage. Matt Amen of ATBS says that only 25 percent of owner-operator truck drivers have worthwhile medical insurance. In 2007, the average owner-operator who spent money on health, dental and vision insurance paid $3,909, or 3.4 cents per mile, Amen says. That’s 7.5 percent of the average net income.

TIPS FOR THE SHORT HAUL
Caring for your body is like caring for your truck in that both involve products and services. The informed consumer knows how to get the best value for both. Here are ways to spend your health dollars wisely.

  1. Shop for medical and dental services. Ask different offices how much they charge for similar services. While the cheapest may not always be the best, three or four contacts should give you a good estimate.

  2. Compare pharmacy pricing. Consumersunion.org reports that stores in the same city often have widely different prices for the same medications. You also can buy your meds online.
  3. Buy generic drugs. By law, U.S.-made generic medicines are required to meet the same standards as their brand-name inspirations, but they’re far cheaper.
  4. Check your medical bills. Even a simple visit to the doctor can produce multiple charges from a lab or X-ray technician, and an emergency room visit or surgery can produce a stream of bills for months. Carefully review any medical bill before paying it. If items are listed as “miscellaneous” or coded, ask for details. Scrutinize statements from your insurer just as carefully.
  5. Negotiate rates. The National Insurance Resource Center’s website suggests that negotiation may work (that’s a strong may) for people without insurance in getting medical expenses reduced before the service is rendered. It never hurts to ask.
  6. Get a second opinion. If your doctor or dentist suggests a major operation or procedure, get another opinion. Some insurance policies require a second opinion for certain major procedures, so you could be liable for a big bill if you fail to do so.
  7. Verify coverage. If you’re insured, check with your provider to make sure any procedure that’s new for you, especially with a specialist you haven’t used before, is covered.
  8. Appeal insurance rejections. Most insurance companies have an appeals process in the event an expense is denied. Don’t fret yet. Most insurance companies allow for three appeals on a single issue. A bonus tip: Have your doctor or dentist provide a written explanation of why the procedure was necessary.
  9. Avoid hospital emergency rooms. If you’re suffering a heart attack or serious injury, use a hospital emergency room. Otherwise, they’re too expensive and often have long waits. Many communities have walk-in clinics that treat common problems such as colds, flu, broken limbs and cuts. There also are a small but growing number of truck stop clinics that serve drivers on the road who fall ill, including Highway Health Care in Texarkana, Texas, and several locations run by Professional Drivers Medical Depots and Roadside Medical Services.
  10. Keep up with tax-deductible expenses. Many medical-related items are tax deductible, including doctor and dentist fees, false teeth, prescription eyeglasses, hearing aids and crutches. Such expenditures “are only deductible in excess of 7.5 percent of the taxpayer’s adjusted gross income,” says Mark Miller, a tax manager at ATBS. “Unless a taxpayer has a lot of expenses, it is difficult for the taxpayer to see a real advantage in medical expense deductions.” And don’t create headaches for your tax preparer by mixing in receipts for drugs or medical services for which you’ve already been reimbursed through your insurer. Check with your tax preparer or visit www.irs.gov/taxtopics and go to topic 502 for more details.

TIPS FOR THE LONG HAUL
Preventive maintenance works. The more you keep your body in shape, the less downtime you’ll experience, and the less you’ll spend getting yourself fixed. These best practices will, over time, prevent you from spinning your wheels in the doctor’s waiting room instead of keeping them turning on the road.

  1. Get regular exercise. When you’re taking a rest period, instead of watching TV or other passive activities, exercise. Some things you can do in your cab, such as sit-ups, jumping jacks and stretches. Walk – or jog, if you can – around the truck stop lot. Whatever level you’re capable of, try to exercise four or five times a week.

  2. Eat healthful foods. Stay away from the fast food and grease common on truck stop diner and fast food menus. While an occasional moderate indulgence is OK, try to mix in more low-fat meals – heavy on salads, vegetables and fruits. Most truck stops now offer such choices. Bob Perry of Roadside Medical Clinics, which caters to truckers, advocates a total ban on fast food and processed foods, which includes anything with “instant” on the label or marketed as a quick microwave or stovetop meal: TV dinners, boxed oatmeal, canned pasta.
  3. Drink more water. Too many people “reach for a Mountain Dew or a Diet Coke when they become dehydrated,” Perry says. But all these drinks, as well as beer and other alcoholic beverages, can further dehydrate you. Instead, reach for a large glass of water just after you wake up and just before you go to bed, Perry says. Water “cleans out toxins, kicks your metabolism into gear,” he says.
  4. Avoid diet fads and energy drinks. “They run your body out of energy,” PDMD’s McElligott says of energy drinks. “You’re expending energy you will never catch up on.”
  5. Shun tobacco products. Use of cigarettes or smokeless tobacco is life-threatening. The sooner you quit, the better.
  6. Don’t be a substance abuser. Trucking is a hard job, but if you’re relying on heavy drinking to “unwind,” you’re kidding yourself. The same goes for using illegal drugs or abusing prescription medication.
  7. Get an annual physical. “There’s no substitute for the family physician,” McElligott says. ATBS’ Amen adds that it’s critical for drivers to be checked out at least annually: “Your DOT physical does not serve as an annual physical from a doctor.” You should be screened for eye disease, excess cholesterol and other conditions (see page 30). Testing for sleep apnea, a condition that is more common among truckers, is now available at some carriers through Sleep Pointe’s outfitted trailers and the company’s other facilities.
  8. Ensure your records are accessible. If you get sick on the road and are able to, call your physician (or dentist) to have medical files and X-rays forwarded to an on-the-road clinic. Also, companies such as MedicAlert and American Medical ID offer services that store your medical information on USB jump drives or scrolls that can be carried on a key chain. Wallet medical cards are good for listing blood type or conditions such as diabetes.
  9. Follow doctor’s orders. Whether it relates to special diet, daily exercise, sleep or medication, it’s critical to stick with a prescribed regimen. For example, truckers often take medication for a brief period, then stop, Perry says. Doing so without a doctor’s authorization can undo any efforts to correct or control your illness.
  10. Get insured – at least a little. McElligott and Perry urge having at least catastrophic insurance in the event of an accident. The coverage is relatively cheap because less expensive health care needs are not covered. The earlier you get any coverage, the better, because many insurers won’t take on non-insured clients who have certain pre-existing conditions. Many insurers post online calculators for you to gauge prices.
  11. Avoid paying by credit card. Unless you’re paying off your entire balance every month and know that you can do the same with additional medical costs, stay away from credit. If your account charges 18 percent to 20 percent, even a $2,000 bill that takes months to pay could cost hundreds of dollars more before it’s over with. Instead pay in cash, use savings, or set up a payment plan with the provider’s office.
  12. Don’t forget your teeth. Brush and floss regularly. Lay off artificial sweeteners and sodas, says Perry. When scheduling regular check-ups with your doctor, also make an appointment with your dentist. Small dental problems can grow into major ones in time.
  13. Know your body’s limits. Don’t injure yourself with a pulled muscle, joint, or other injury by lifting or reaching for an item that is out of your range. This rule applies not only to securing a flatbed load or wrestling cargo out of your van, it also applies to home projects, such as climbing ladders.
  14. Listen to your body. If you have any unexplained symptoms, see a doctor – now. “If you do a better job of taking care of yourself, you won’t be hit with these medical issues and bills, and the medication, and the regular checkups,” Perry says.
  15. Know your parents’ medical histories. If your father’s side of the family has heart problems, for example, pay careful attention to the way you treat your heart. Attend likewise to family histories of high blood pressure, diabetes, cancer, allergies, etc.

High-deductible insurance
A traditional health insurance policy might be too expensive, but that doesn’t mean you have to go without any coverage at all. One option is “to have a high-deductible medical insurance plan, which can then be associated with a Health Savings Account,” says Mark Miller, a tax consultant with financial services provider ATBS.

Set up properly, such a plan can give an owner-operator the advantage of paying all medical expenses with pre-tax dollars, meaning a lower tax bill. “The list of expenses that qualify for payment with pre-tax dollars is also much more liberal than what would be otherwise deductible as an itemized deduction,” Miller says.

That’s why ATBS launched its own major medical insurance program, Trucker’s Health and Income Security Plan, with partners Aetna, Beta Health Association and Colonial Life. The insurers offer, respectively, health insurance with a $3,000 embedded individual deductible, dental and vision coverage and life, accident and disability coverage. Launched in February, the program is designed to get owner-operators needed health care coverage for themselves and their families.

Families within the plan commonly pay $350 per month in health insurance premiums with an $6,000 deductible, says Dennis Carter, an insurance consultant with Adrian & Associates Inc., who helped launch the program. One added bonus: Even if the driver is denied health coverage because he has, say, diabetes and is a smoker, his family still can obtain coverage.

The Owner-Operator Independent Drivers Association offers its members programs including prescription drug discounts and accidental death and dismemberment. Professional Drivers Medical Depots also has launched Professional Drivers Insurance Program, with limited medical programs, dental and vision coverage and short-term disability.


Heading off problems
In addition to a complete physical every year or two, screenings such as these can help keep health care expenses down:

PROSTATE CANCER. This test should be done yearly through a digital rectal exam and blood test, starting at age 50.

COLORECTAL CANCER. Starting at age 50, various tests are recommended anywhere from a blood test annually to a colonoscopy every 10 years.

SKIN CANCER. A doctor may do a full body exam annually to detect precancerous or cancerous growths, starting at age 50.

BLOOD PRESSURE. Because blood pressure at high levels can indicate a heart risk, it should be measured at least every two years.

CHOLESTEROL. You should be tested for total cholesterol as well as “good” and “bad” cholesterol, which can be an indicator of heart disease, at least every five years.

DIABETES. If you have high cholesterol, high blood pressure, obesity or a family history of the condition, get tested for diabetes.

SEXUALLY TRANSMITTED DISEASES. If you have had more than one sexual partner or notice unusual symptoms, talk with your doctor about STD screenings.

EYE DISEASE. Routine eye exams are recommended every two to four years, especially past age 40. An annual glaucoma test can check eye pressure and eye health.

SLEEP APNEA. If you have symptoms such as waking up choking or with a sore or dry throat, see your doctor.


RESOURCES
Association of Health Insurance Advisers
(703) 770-8200
www.ahia.net

Health Insurance Finders
(909) 335-9703
healthinsurancefinders.com

Health Insurance Resource Center
www.healthinsurance.org

Insurance Information Institute
(212) 346-5500
www.iii.org

Insure.com
(800) 324-6370
www.insure.com

OOIDA
(800) 715-9369
www.ooida.com

Professional Drivers
Medical Depots
www.pd-md.com

Professional Drivers
Insurance Program
(866) 817-9674
www.pd-ip.com

Roadside Medical Clinics
www.roadsidemed.com

Sleep Point
(316) 425-4019
www.sleeppointe.com

Truckers Health and Income Security (ATBS)
(800) WHY-THIS
www.whythisplan.com

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