Holley Navarre Medical Clinic

Joel Rudman, M.D.



(850) 939-3999

Fax: (850) 939-3935

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Insurance Q&A

Posted on November 7, 2015 at 1:30 PM Comments comments (437)
I'm comparing insurance plans. What are copays, deductibles, and cost shares?
Insurances typically try and encourage consumers to have some type of financial interest in their health, either in the form of high deductibles or regular copays. Copays are a regular amount due at every visit. Cost shares are usually a percentage of the doctor's bill the patient will owe. A deductible is the total amount a patient will pay before their insurance will begin paying medical claims.

When is a deductible "too high"?
It depends on the situation. If you never plan on seeing the doctor and just want peace of mind, you may be willing to pay less for insurance and accept a higher deductible.
Understand that this is not without risk. If you pay $5000 a year for insurance with a $10,000 deductible and you incur $9000 worth of medical costs, your total out of pocket medical expenses for the year will be $14000, and your "insurance" that you paid for will not even pick up a single bill yet.

I don't have a copay. Why did your staff charge me $77.77 ?
As stated earlier, today's insurance options range from ones with low deductibles and high copays to ones with no copay but astronomical deductibles. In today's high tech world, most offices can verify your insurance online and know ahead of time whether you have met your deductible. If your insurance tells us ahead of time you have not met your deductible, they will not be paying your bill for that visit. In that case, we do our best to estimate how much your visit will cost.

Has it always been this way? Healthcare is so expensive. I thought I remember not having a copay or a deductible.
Prior to the recent government regulation and involvement in the insurance industry, there were many different plans out there. Some plans offered by large corporations or small businesses had great benefits with little or no expense to the consumer. These so-called "Cadillac plans" were for the most part eliminated by Obamacare. So yes, you may have had a plan at one time with zero deductible and no copay, but those are unfortunately exceedingly rare in today's political climate.

I have insurance from my company, but I don't want to use that. I'll just use my Tricare insurance instead. Is that OK?
The way the laws are written, it is not up to the consumer which insurance they choose to use. The insurance companies themselves get to decide which insurance pays the bill. If you have two insurances, the one responsible for the bill is called your primary insurance. Generally speaking, government sponsored plans (Medicare, Tricare) are always secondary to a private insurance. The exception would be if you have a supplemental plan, which by definition is always secondary to Tricare or Medicare.

We just won't use my other insurance or I just won't report it to your office or to the claim. OK?
Absolutely not. Insurances devote entire departments, especially Tricare, to discovering whether or not you have other insurance that should be billed instead of them. Most insurances also have a statute of limitations to file a claim. There have been cases where Tricare has discovered other insurance was available and asked for their money back from us. If you fail to report all your insurances to our office, you will be personally responsible for the bill.

I'm having a hard time finding a doctor that takes my insurance. I don't understand it. It has low copays and covers a lot of benefits. Why don't doctors like it?
I can't speak for other offices, but the main reason our office  chooses not to accept certain insurances is due to burdensome paperwork. Some insurances, particularly Medicaid, HMOs, and Medicare HMOs, have significant bureaucratic requirements that small offices cannot meet. For example, some plans may want every lab or Xray pre-approved by some faceless bureaucrat. Other plans, particularly the Medicare HMOs, want a patient's entire chart mailed to them so they can have a record of everything single thing you reported or did. Aside from the massive amount of red tape this generates, I personally have a problem with sharing your sensitive and confidential information with every employee of Blue Cross or Humana. In my opinion, your insurance company in Jacksonville should NOT have access or proof to the time we discussed tobacco use, marital strife, or work-related stress. In a doctor's office, we are used to hearing extremely sensitive information that should not be mailed to insurance companies. I say no to plans that ask me to violate your privacy.

I received a bill, but I remember paying at the time of service. What's up with that ?
In some cases, a copay is collected up front and we are notified later by your insurance that you owe other cost shares. There may be a deductible applied to your claim. Sometimes an amount was collected based on the service we expected to provide (simple visit), but other charges were incurred (EKG, Strep test, tetanus shot).

A Small Victory

Posted on August 28, 2015 at 4:29 PM Comments comments (0)
In my profession, I bear witness to numerous small victories every day. For my patients, it may be another day of sobriety. Another day of being in remission. One less cigarette. One more mile to cycle in order to take off one more pound of weight. Perhaps it's a lower blood sugar on their diabetes screen, another marriage counseling session that a couple has attended, or maybe it's another negative mammogram. Whatever your situation, take the time to acknowledge and celebrate those small victories in your life. 

What It Means To Be Your Hometown Family Doctor

Posted on August 20, 2015 at 8:43 AM Comments comments (100)
     Knowing the star football player personally.
     Having a patient say 'Thank You" for saving their life.
     Starting the day with 20 patients on the schedule and ending
     with 36 because we worked in 16 sick children.
     Taking care of your preacher, your butcher, your banker,
     and your neighbor.
     Writing for the local paper in the first few years of my practice.
     Beaming with pride as my patients go on to play college football
     across America.
     Helping deserving, hard-working students attend Space Camp.
     Sponsoring the football, baseball, cheerleading, tee ball, and
     other youth programs.
    Hiring talented team players who live in the community and
    make a difference in the community.
    Advising a young lady on a positive pregnancy test.
    Counseling  a grieving patient on the recent loss of a loved one.
    Sharing stories with patients about common themes, missed 
    opportunities, life lessons, and beloved canine companions.
      It's called being the local family doctor.
      In challenging times where doctors are selling practices and
      retiring, these are just a few of the things that make it all
      worthwhile. Thank you to my patients who allow me to do
      what I love every day.

How the Healthcare Laws Affect Your Town

Posted on April 30, 2014 at 1:00 PM Comments comments (208)
We were told that recent changes to the US healthcare system would result in some serious strain on the system for doctors and hospitals.
Here in Navarre, we are unfortunately now seeing some businesses crack under the pressure.
In one month, we have learned of two significant closures just in our area. For several years, we have been very blessed to have an Open MRI facility here in our town. I am sorry to say that service is now closed forever. You may not know that these stand-alone facilities are not extremely lucrative; Medicare (and other insurances like Tricare) actually pay such places at a lower rate than a hospital-owned MRI. So while it was already difficult for such local places to tread water before the Affordable Care Act, I'm afraid the latest changes of Obamacare were the final nail in the coffin. Upon hearing of the impending closure, I called a local hospital executive in an effort to keep our access to local MRIs available. I was simply told "There's no money in MRIs anymore".
The same week, I was stunned to learn that our local urgent care was also going away. For years, Navarre has had a freestanding urgent care center building run by Baptist Hospital, often to varying degrees of success. After some significant feedback from the community (and me), a determined effort was made to open the Baptist Urgent Care Navarre, a facility to provide after hours and weekend care for our families. While there are other businesses that claim to provide urgent care services or "quick care", the Baptist facility was the only one to actually have a physician see the patients. Also, the level of equipment and resources was on par with what one would expect from an urgent care. It was actually my hope that in our lifetime, the facility would eventually upgrade to 24 hour service and perhaps be the basis for a future hospital in Navarre. Nevertheless, after a year of providing high quality services to the people of Navarre, an executive decision was made to pull the plug on the urgent care idea, starting in July. Again, financial considerations in the wake of Obamacare seemed to be the deciding factor.
While it's too late to save the Open MRI center, it's not too late to save our Baptist Urgent Care. When our child falls and hurts his ankle at 6 pm, we don't want to go sit in the ER 30minutes away. We also don't want to see someone who's not a doctor to guess what's wrong. We have been very blessed to have Baptist and their high quality of care in our region for so long. I've heard nothing but praise for Dr. Olsen and the care he's provided to our sickest patients afterhours. If you value having a high quality, reputable urgent care center in your backyard, staffed by board certified physicians, with all the equipment of an ER with IVs, CT, and labs, then join with me in contacting Baptist's CEO, Mark Faulkner, at 434-4011. Let him know that the current afterhours urgent care, as an alternative to an ER trip, is what Navarre needs, not another medical office.