We now offer medical evaluation and use of the newest cold laser treatments for different types of aches and pains. This is helpful in avoiding pain medication and pain medication dependency.

We now provide full acne treatment for teenagers and young adults. These medical procedures span a comprehensive spectrum of treatments including topical medications, oral medications, acne lasers, acne peels and medical dermabrasion.

The delivery of medical care is in a state of confusion and uncertainty. We observe that more and more patients have a difficult time with accessing appropriate medical care. We will continue to see patients with PPO insurance as before. For those patients who have lost their insurance, or cannot find a doctor who will take the insurance they have, we are making it affordable for you to become a private pay patient. Our fee is $75 for a basic office visit. This fee includes any test that we can do in our office, including a blood count. Follow-up visits for the same patient are $50. Please call our office manager or Dr Horvath if you have any questions.

Previously, our young adult patients had to look for a physician at age 18. Due to changes in medical care, we now continue to see our young adult patients with PPO insurance until the age of 26.

Our nutritionist is now available on thursday afternoos and saturday mornings every week. Before you are able to schedule these appointments, we have to do a medical evaluation and appopriate labwork to create an individualised counseling plan to improve your lifestyle and enable weight loss.

                ***************** ARCHIVED NEWS *****************

* YEARLY EXAMS ARE PART OF YOUR HEALTH MAINTENANCE. Different tests and screening procedures are done for different age groups. Most insurance plans waive copayments for routine physical examinations in an effort to prevent long term illnesses.
* As you are well aware, we no longer have a family practice doctor with us due to changes in medicine. Nevertheless, we will see you for any acute illnesses if you wish to stay with us. In that case, we would appreciate any lab work of significance to be sent to us to maintain in your chart.
If you already have a primary doctor, and wish to transfer to them, please ask for your records to be transferred. Due to lack of storage, records that are not transferred within two years of your last office visit will be taken to storage. At that time, any transfer will incur a fee.
A lot of our younger patients (up to 40 years old) have decided to stay with us. If you are in that group, you will need to have yearly examinations to be in compliance with your insurance requirements.
* For working adults that cannot come to our office during work days, we have a certain number of appointment time slots for physical exams available on Saturdays. These slots are on a first come first served basis, so call early to book yours.
* We also have two nutritionists available to help with lifestyle and metabolic diseases.

2014 will be a year of big changes in the delivery of medical care. We will have many new laws governing the health care for the government and the insurance companies. It appears that we are moving towards socialized medicine. More and more of healthcare will be delivered by large groups like Kaiser, Medical Foundations, Medical and Medicare. Private practices are less likely to survive due to high costs of operating the private offices in the present climate. No matter what happens in 2014, I would like to continue to be your Doctor, but to be able to do that I will only be able to see patients on PPO plans and privately paying patients. For those who have no insurance or those who change to insurances I do not take, I offer to continue to take care of you privately at a reasonable cost to you. Expenses to bill insurances when I have private patients will be saved and we can discount the cost of office visits accordingly. As we already experienced in 2013, the cost of running medical offices will be prohibitive. Obviously if the cost of running our office exceeds what we collect from patients we would have to close the door. That would be the last thing I would want to do, since it took me many years to learn and perfect what I know so I could keep my patients as healthy as possible.

Up to now patients passively received medical care, but now it is up to patients to help us stay in practice. How can you help?

• Always carry your current insurance card with you and show it to us at every office visit
• We have limited time to submit any claim to your insurance after your office visit. If we do not get your correct insurance card we will end up billing the wrong insurance company and the claim will be denied and we will not be paid. If we then have to rebill the correct insurance at our cost, we will lose money on the claim by rebilling and if we are late in the rebilling we lose the claim altogether
• For that reason, if patients do not submit the correct (current) insurance card they will be billed privately
• Know the details of your insurance coverage

New insurance coverage in 2014 will include high deductibles and higher copayments. It would be helpful if patients with high deductibles pay partially towards each visit, especially if there is a good chance they will not meet their deductible in that calendar year. We will keep an account of what each patient pays and what the insurance pays for each office visit and the patient deductible will be reduced as usual.

We no longer have extra staff to prepare forms without getting compensated for extra paperwork. If you bring the form completely filled and only requiring our signature then there will be no charge. If you will bring the form at the time of the patient physical exam while we have the patient chart available, then there will be no charge. All other form matters will carry a fee from $5 to $25 according to the complexity and the time required.

In 2014 we will not automatically refill prescriptions, with the exception of vitamins, contraceptions, etc especially if there is no recent office visit related to the problem that the prescription was made for. I will make an attempt to make a refill when the original prescription is filled, according to what the insurance allows. More often, if there are prescriptions refilled repeatedly, insurances will send us requests to justify frequent refills. This will create extra work for the doctor that we are not compensated for. If you have the right to refill, ask the pharmacy to send us a fax request and we will refill it in the proper timespan.

If you change your insurance and change to a different physician your medical records can be forwarded after you request in writing for us to copy the records, unless it is only 2 or 3 pages, we will ask you to pay the fee or you can use a copying service of your choice. As it is now with constant changes we spend excessive time copying medical records and we no longer have enough staff to use time unless you request them in writing and pay the prorated fee. The fees have to be paid before we copy the records. Most importantly, under HIPAA regulations, the patient must request in writing a copy of their records before we can proceed. If you change to a different physician, after a few months, your medical records will be placed in storage, and will become more difficult for us to access. If you are changing to a different physician, do not wait months to get copies of your records. If your records have to be retrieved from storage, there will be an extra fee to retrieve them on top of the copying fees.

We have 24 hour coverage for our patients but we would appreciate if the usual problems are dealt with in the office hours. After office hours we like to only handle urgent or emergency problems. Between 10pm and 7am our calls are triaged by nurse practitioners and they charge us $18 for each phone call. That, in 2014, will be passed on to you, with exception to those from calls that result in sending the patient to the emergency room, those I will absorb. Every insurance company has nurses available 24 / 7 to answer patients questions. If the nurse says you need to call your Pediatrician, then you should call the office number or the exchange. The office number is (408) 295-8988. The direct exchange number is (408)345-2030.

If you have questions and ask for the doctor to call you back, make sure your phone is not busy and is available for us to communicate with you. We are losing a large amount of time attempting to return calls to patients who request a call back and

• Our call goes to voicemail
• Our call goes to voicemail and the voicemail is full or not set up
• The phone keeps ringing and no one answers
• The patient has left the wrong number

If you call the office we have several openings set a day for sick visits. If you are not sure if the child needs to be seen, call early and I will call you at lunch time in case there is an appointment needed for the patient. Questions that do not require an office visit I will answer lunch time or after office hours.

I tried to build a family practice for our older patients and our families by using two part time family physicians to do routine care like physicals and follow up to complex problems. Unfortunately, with the changes in the delivery of medical practice and medical care they no longer can work in my office since they cannot practice in more than one location so they do not compete with themselves. In 2014, it will be very hard to include another family practice physician due to the fact that most physicians now look for large group practices and our family practice is too small to be able to meet the financial demands. As I learn over the past few years, adult patients are less likely to do the routine care and instead utilize urgent care far more than our office. That does not bring the revenue to hire a full time family physician. While I do not have board certification in family practice and only in pediatrics, I am able to see my adult patients if they choose to stay in our family practice. Under new medical care rules I can see young adults in pediatric up to age 26. Since there is no magic between ages 26 and 40 in delivering medical care, I will continue to be available to all my adult patients, with the understanding that I do not have board certification in family practice, there are a lot of physicians who practice general medicine without board certification. Nevertheless, patients with complicated medical history should obtain care from an Internist or a General Practitioner in order to ensure the quality of care that their complex problems require. Patients that come to our office for sick visits should identify on our information sheet who is their primary physician since insurances frequently request information like copies of their physical examinations, their laboratory results and their medications. We would only have that information if it is forwarded to us. If our patients are seen in emergency rooms or urgent care under new privacy rules we can only obtain the results of these visits if the patient releases it to us while they are there. If the patient comes for a follow up visit we have to send a record release which slows down the process and very often we don't get the records on the same day. For now all it requires is verbal cc to Dr. Horvath via fax (408)295-8731 or via email to dagmar@metafusion.net.

2013 is here. There will be many changes to medical insurance for many of patients. There will likely be increasing costs of medical insurance premiums, increasing deductibles and increasing copayments. Due to inflation and the faltering economy, employers are being forced to look for cheaper health insurance alternatives. They will more likely be offering HMOs and the Kaiser system. Even though patients will have to switch to these plans due to economic reasons, many prefer to stay with Dr Horvath. For this reason, Dr Horvath will be providing private office visits to these patients at very affordable fees, and substantially discounted below usual private office visit fees. As a result of this inexpensive healthcare option, patients can switch to their new insurances but continue to see Dr Horvath privately and affordably. Also patients on PPO plans with high deductibles (which they are not likely to use up during the year) and high copayments can see Dr Horvath privately for affordable fees, and use their PPO insurance for hospitalizations and ER visits. For more information call our office and speak to the billing department.

Due to changes in the delivery of medical care more and more physicians are becoming part of large medical groups and clinics. Smaller and smaller numbers of physicians are staying in private practice. Dr Horvath will stay in the same private practice in the same location. Unfortunately, our good friend and colleague Dr Duchicela made the decision to join O'Connor Medical Foundation, and his employment agreement prevents him from continuing to divide his time between O'Connor Hospital and our office. Fortunately he will be practicing in close proximity of O'Connor Hospital and is willing to continue seeing adult patients that like him and like to stay with him. Dr Horvath and Dr Navarro will continue to see all of the adult patients for illnesses and we expect a very smooth transition. We're going to miss having Dr Duchicela in the office and wish him all the very best in the future. For more information about contacting Dr Duchicela, his phone number and website, please call our office.

Looking at the big picture, insurance companies are becoming more difficult to deal with. And a national survey shows that only 11% of patients fully understand their medical insurance policy. One of the causes of increasing difficulty and waste starts with a patient giving us the wrong insurance information or not updating the correct insurance information at the time of each office visit. We have experienced increasing numbers of insurance claims that have been dishonored and unpaid as a result of wrong insurance information supplied by the patient or failure to update the correct insurance information at the time of an office visit. This results in increased cost to our office and larger out-of-pocket liability to the patient. It is therefore very important for patients and parents to find out about their insurance policies and also be very aware of all the changes to their insurance coverage and notify us with new insurances and new co-pays and deductibles ASAP so we can bill the right insurance company appropriately and on-time the first time around.

Due to increasing costs and labor involved in billing insurance companies, we are no longer able to bill secondary insurances.

We are also no longer able to re-bill the primary insurance company if a patient gives us the wrong insurance information at the time of the office visit and then provides the correct insurance after we have billed the primary insurance company. This is because we find that very often insurance companies will not honor the second corrected bill.

If you have any questions, please contact our billing department.

Our office will be working more intensively on nutritional health issues. Now that there are more overweight children and adults, and the cost of medical complications as a result of obesity is increasing, insurance companies are starting to recognize that weight gain and obesity are medical illnesses. As a result, insurance companies are starting to cover nutritional counseling and monitoring in patient insurance plans. Pediatricians must address excessive weight gain even in babies and toddlers, even though it is one of the hardest sells to try to change the habits that the children were raised with. For adults there will be access to newly-approved weight loss medications that produce not only loss of appetite but change the brain's perception of excessive eating. Contact our office for more details.

Health insurances are changing due to problems with the economy. A lot of people seem to be losing their insurances, Also a lot of people seem to have higher deductibles which leads frequently to patients or parents trying to avoid or minimize office visits that frequently result in more complicated health issues that sometimes take longer to resolve and frequently actually require more resources that would not be necessary if problems were caught early. More & more rely on the internet and friends and neighbors for diagnosis which can also result in serious undiagnosed and untreated health problems.

Because of these economic and social changes, in our office we will see patients without insurance at private discounted fees so that we help minimize and prevent such occurrences.

We are excited that our office acquired one of the newest lasers that can treat several medical problems.

We have been successfully treating acne for a few years already and the new laser seems to be a lot more effective for select types of acne.

We have started treating nail fungus and ingrown toenails and warts

As of now, we are reserving these treatments only for our patients mostly because our fees compared to other clinics are deeply discounted and there is a limit of how many procedures the doctors can do in 1 week. Before we can treat these conditions with the new laser, there is a consultation to see if the problem is suitable for treatment with the laser.

As of Oct 1 we are staring to administer flu shots.

We will 1st charge the insurance companies and only if they do not pay we will then bill our patients.

Patients need to call on or before the day that they want to come for their flu shot so that our staff has time to prepare the charts.

We will administer flu shots also on saturday mornings from 8;30am to 12:00pm.

Babies from 6 months old and up will receive 2 flu shots 1 month apart if they have had no previous immunizations. Children under age 3 will receive the most purified vaccines without preservatives.

We are receiving numerous different types of school forms, camp forms, medication forms, school excuse notes, and immunization proof forms.

We need a minimum of 5 days to process the requests. The only time that we can fill in the form sooner is when the patient is present for a physical or office visit and requests the form to be filled out.

If you need a medication refill please contact your pharmacy first. Pharmacies usually fax us your refill request and will help us to turn the prescription over quickly.

Patients should have their pharmacy number ready when they call the office to obtain a prescription.

We are finding that more of our callbacks to patients are being answered by voicemail. Please ask for a callback only when you are ready and available to receive the callback and will be ready and answer instead of the call going to voicemail repeatedly.

Also it would be helpful when the patients call with questions to leave their phone number whether or not we have recorded it in the chart.

Because of rising costs of healthcare, we need our patients' cooperation and diligence in providing us up to date status of their insurance to avoid unnecessary billing which is costly and time consuming.

Any change in insurance status, co-pay status and insurance addresses must be updated in our records as soon as possible. Your continued cooperation will help our office to continue running smoothly and avoid wrong billing and unnecessary time on the phone.

NEWS --- Lifestyle illnesses

Medicine is changing. Due to routine immunizations and advances in treatment of chronic diseases we see less life treatning diseases, but we see a lot more life style illnesses that can be just as serious.

Dr. Horvath and Dr. Navarro are in the process of creating a medical home page with emphasis on illness prevention, fitness and well being.

It takes your willpower to prevent lifestyle illness, and our guidance. Ask us about it.

NEWS --- Acne treatment in our office

Severe acne cases are still reffered to dermatologists. And of course any patients that prefer to see a dermatologist should go to the dermatologist for treatment.

We are using multiple aproaches for treatment of moderately severe acne.

Besides medications for treatment of acne, we use FDA approved equipment that helps to clear skin problems very effectively.

Good news: Dr Navarro has completed her Training in Dermatology Procedures for Primary Care Practice and can provide the same services for her adult patients.

Due to the fact that some of the procedures are time consuming and have to be done by the physician they are usualy scheduled near the end of our office hours, usually between 5 and 5.30 pm. and occasionally on saturdays.

Since we charge very little for these services we are limiting them ONLY TO OUR PATIENTS.

NEWS --- Write this down ! Alternate phone numbers

Due to the recent storms, our office lost electricity on one occasion and patients had no way of reaching us by phone. Please write these alternate phone numbers down so you can use them in the future in case the same problem happens again:

(408) 345-2030 and (408) 295-9362

You cal also use the number (408) 345-2030 if you would like to reach us after hours and do not wish to listen to our office phone system recorded message. The recording will also give you this number is you forget it.

NEWS --- Appointment Cancellations

If at all possible, please let us know ahead of time if you cannot maske it to your appointment. This is most important for the saturday office visits for Dr. Horvath and Dr. Navarro. Krystina, who sees patients for weight control and exercise management on saturdays, would appreciate this also, especially as there are many patients waiting for appointments with her.

MANY PATIENTS WOULD LIKE SATURDAY APPOINTMENTS, SO IF YOU KNOW AHEAD OF TIME THAT YOU CANNOT COME, PLEASE LET US KNOW AND WE CAN CALL PATIENTS ON THE WAITING LIST AND FIT THEM IN. THANK YOU.

NEWS --- After Hours Consultations

This office has after-hours consultations for behavioral problems and attention deficit problems in children and adults. With available treatment, there is great improvement in school and work. In complicated cases we also work with developmental neurologists and psychologists to achieve the optimum results.

NEWS --- Vaccinations for the flu season

The weather is great but the flu season is coming. Our flu vaccines are going fast, especially those for younger children formulated without preservatives. There are still a lot of patients out there with chronic illnesses, especially asthma, that need to have their yearly flu vaccines before we run out.

NEWS --- Saturday office hours and you

Saturday office hours are no longer only for illnesses. Between Dr. Horvath and Dr. Navarro, we are now able to perform physical exams for patients that have cannot find time during workdays. Before scheduling your physical exam, please obtain the packets that Dr. Navarro designed from our office.

NEWS --- Take advantage of your deductible

If you have met your deductible, schedule your physical exams or chronic problems that may require x-rays or specialist evaluations in November and December.

NEWS --- PROJECT KRYSTINA brings healthy weight management under medical supervision

To keep up with changes in medicine, and to keep up with problems brought on by our stressful lives, processed foods and lack of exercise, we have Krystina help us on saturdays with nutritional education and exercise hints, under our medical supervision. Krystina schedules in 30 minute slots, and we are asking everyone to please be on time. Like any other office visit, co-pays are payable. This program is becoming very popular, and Krystina's timeslots are filling up quickly. Don't miss out.

NEWS --- Acne treatment trials prove to be a great success

Our acne treatment trial is now completed, and all your clear acne-free faces are our best proof of its great success. If you want to benefit from this treatment, just ask some of our patients who have been through it. The treatment does require adherance to a regiment devised for each patient according to their individual needs, and you need to give it enough time. It is well worth the effort.