To Protect Providers Against Business Losses, Many Health Plan-Provider Contracts

To protect providers against business losses, many health plan-provider contracts include carve- out provisions to help providers manage financial risk. The following statements are examples of such provisions: The Apex Health Plan carves out immunizations from PCP capitations. Apex compensates PCPs for immunizations on a case rate basis. The Bengal Health Plan carves out behavioral healthcare services from the scope of PCP services because these services require specialized knowledge and skills that most PCPs do not possess. From the answer choices below, select the response that best identifies the types of carve-outs used by Apex and Bengal.

A) Apex: disease-specific carve-out Bengal: specialty services carve-out
B) Bengal: specific-service carve-out
C) Apex: specific-service carve-out
D) Bengal: disease-specific carve-out