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Do you receive a financial incentive to limit care as part of your (AQC) contract with Blue Cross? Will I be denied services?

Through the AQC, there are no financial incentives to limit care. In fact, there are incentives that reward the PCP for good quality of care, such as making sure that you are getting the tests and services you need to maintain good health (like mammograms) and to carefully manage chronic illnesses (like making sure patients with diabetes get necessary tests). As your PCP, my priority is to help you get the right care, at the right time, and in the right setting. This is consistent with the oath doctors take to "first do no harm."

Part of our job is to make sure that you get what you need quickly and efficiently, often in your own community, and to help you avoid tests or procedures that may not help you and that may potentially harm you. I am part of a group of doctors that has agreed to be reimbursed based on how well we take care of a large group of patients rather than being paid based on how many tests, visits, and procedures are performed. We are accountable for the quality of care for each patient, for the efficiency of care for the whole group, and for the positive experiences of the patients cared for by the group.

I came in for a preventive service, but now I received a bill for a deductible. What is this for?

When you see your doctor for preventive services such as checkups, screening tests, and immunizations, sometimes you may receive diagnostic services. Diagnostic care is what you get when you have symptoms of an illness or injury, or are being followed for a chronic condition and your doctor wants to diagnose or monitor the condition. This may include an office visit, tests, or treatment. For example, during a checkup, your doctor may discuss a chronic illness you have. Some of the tests ordered that day may be preventive (such as a colonoscopy or mammogram) and others may be diagnostic (such as a blood sugar test for a diabetic).

In most cases, you don’t pay anything for preventive care, but you may have to pay something for diagnostic care. And, if you have both preventive and diagnostic care at the same visit, you may have a copayment, deductible, or co-insurance.

If you have specific questions about your plan and what is covered, you can access your benefits online at bluecrossma.org, or call the Member Service number on your ID card.

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