I'm a Medicare beneficiary (part A and B) with Federal employee insurance (BCBS) as a secondary payer.
When I was in my 50s, I was diagnosed with a rare form of cancer, originally misdiagnosed at a well-respected hospital overseas, but caught by the path lab at Johns Hopkins and confirmed by the tumor board at UCLA medical center. Before the pandemic, I saw a specialist at Hopkins annually for follow up. I paused all visits since 2020, but am looking to get back to regular follow up. Despite the huge respect I have for JH, I am tired of driving to Baltimore (60 miles) and tired of dodging the squeegee men in downtown Baltimore. While the DC metro area where I live is generally well stocked with specialists of all sorts, the only one I have found with experience with my specific type of cancer is at George Washington University hospital. And all the physician practices at GW are ACO reach practices, as far as I can tell.
I really do not want to be "aligned" with ACO reach, and my primary care physician is not part of a reach practice. My goal is to keep my medical care between myself and my physicians to the extent possible. Perhaps I'm missing something obvious, but I've been unable to find the answer to the question of what happens when your primary care doc is not in ACO reach, but you see a specialist who is. Am I overcomplicating this?
When I was in my 50s, I was diagnosed with a rare form of cancer, originally misdiagnosed at a well-respected hospital overseas, but caught by the path lab at Johns Hopkins and confirmed by the tumor board at UCLA medical center. Before the pandemic, I saw a specialist at Hopkins annually for follow up. I paused all visits since 2020, but am looking to get back to regular follow up. Despite the huge respect I have for JH, I am tired of driving to Baltimore (60 miles) and tired of dodging the squeegee men in downtown Baltimore. While the DC metro area where I live is generally well stocked with specialists of all sorts, the only one I have found with experience with my specific type of cancer is at George Washington University hospital. And all the physician practices at GW are ACO reach practices, as far as I can tell.
I really do not want to be "aligned" with ACO reach, and my primary care physician is not part of a reach practice. My goal is to keep my medical care between myself and my physicians to the extent possible. Perhaps I'm missing something obvious, but I've been unable to find the answer to the question of what happens when your primary care doc is not in ACO reach, but you see a specialist who is. Am I overcomplicating this?