Dear Medicare Beneficiary:
Please review and sign this form below to let Medicare know that the Primary Care Provider you select is your Main Healthcare Provider.
Medicare has started an initiative where healthcare providers who share a common set of goals aimed at improving patient care can work together more effectively. This initiative brings together healthcare professionals in an Accountable Care Organization (ACO), to work together with Medicare to give you more coordinated care and services.
Your provider is voluntarily taking part in this new initiative by joining The Physician Leaders Direct Contracting Entity, LLC ACO REACH (PLDCE) because we think it will help us provide better quality care for our patients.
You are receiving this letter and form because your doctor or other health care professional thinks that you might benefit from care coordination and preventive services offered by PLDCE.
You can use this form to confirm that your provider is the main doctor or other health care professional you see or the main place you go for routine care, to help determine if PLDCE should help coordinate your care. Routine care can include regular care and check-ups you get from a doctor or other health care professional and care for other chronic health problems, such as asthma, diabetes, and hypertension.
Alternatively, instead of signing this form, you can also log into Medicare.gov and select your main doctor or other health care professional in order to determine whether PLDCE should help with coordinating your care. If you make a selection on this form and make a different selection through Medicare.gov, Medicare will prioritize the most recently submitted selection.
Your benefits will NOT change, and you can visit any doctor, other health care professional, or hospital.
Whether or not you complete this form or select a doctor or other health care professional through Medicare.gov, you remain eligible to receive the same Medicare benefits and you still have the right to use any doctor, other health care professional, or hospital that accepts Medicare, at any time. If you have questions, feel free to ask your doctor or other health care professional, call PLDCE at 1-844-570-1010, or call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask about ACOs. TTY users should call 1-877-486-2048.
Completing this form or selecting a doctor or other health care professional through Medicare.gov is your choice AND you can change your mind.
If you choose to complete this form or select a doctor or other health care professional through Medicare.gov, you should do so yourself. No one else should complete this for you.
No one is allowed to attempt to influence your choice to complete this form or select a doctor or other health care professional through Medicare.gov by offering or withholding anything in exchange for you to complete or not complete the form or to make a selection online. If you feel pressured to sign or not sign this form or to make a selection online, please call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Please call 1-844-570-1010 or update your online selection if you change your mind later about whether you consider your provider to be the main doctor or other health care professional you see or the main place you go for routine care.
Sincerely,
The Physicians Leaders Direct Contracting Entity, LLC ACO REACH
Get more information about ACOs
CMS Website: www.innovation.cms.gov/innovation-models/aco-reach
ACO REACH Website: www.physicianleadersacoreach.com
Confirm your doctor below. We’ll do the rest.
Please fill in the information below about your primary doctor or other healthcare professional that you see for routine medical care. Submit the form and you will be on your way to a new kind of patient care.