Knee and hip replacement
The Center of Excellence (COE) Program is a new UMP benefit that covers knee and hip replacement surgery at little to no cost for qualifying UMP Classic and UMP CDHP members.
For complete information, read the COE Program section in your UMP Classic Certificate of Coverage.
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The Health Care Authority (HCA) strives to create a healthier Washington by providing high-quality health care at lower costs to those we serve. That is why HCA has created the COE Program for eligible UMP Classic and UMP CDHP members.
Through this program, HCA contracts exclusively with providers who specialize in treating certain medical conditions. These providers are named Centers of Excellence because they have proven their ability to provide excellent service with successful results for patients with those conditions.
HCA has chosen Virginia Mason as the Center of Excellence for knee and hip replacement surgery. This program is only available at Virginia Mason.
This program is open to UMP Classic and UMP CDHP members who:
- Are age 18 or older.
- Have been diagnosed with osteoarthritis or another disabling condition that requires a knee or hip replacement.
- Are not enrolled in Medicare as their primary coverage.
Note: This program is not available for members enrolled in Medicare as their primary coverage or for UMP Plus members.
For UMP Classic members, the surgery and related services you receive at Virginia Mason are covered in full.
The COE Program does not cover:
- Services needed to prepare for surgery (such as tobacco cessation or weight loss).
- Care you receive when you get home (such as physical therapy).
These services are covered under your normal UMP cost share (subject to your deductible, coinsurance, and copays).
The COE Program may also cover travel and expenses for you and your approved care companion. All travel arrangements must be made through Premera to be covered. If you choose to drive, mileage reimbursements are determined by the IRS rates for medical mileage. If you choose to fly, you must travel to and from one of the airports listed on Premera's COE page.
Your regular provider can refer you to the COE Program, or you may contact Premera at 1-855-784-4563. If you are already seeing a Virginia Mason physician, they can also refer you.
Premera representatives will first determine if you are eligible for the program. Next, Virginia Mason surgeons will review your medical records and discuss with you whether surgery is the right option at this time.
Visit Premera's COE page for more information about Virginia Mason's clinical review requirements.
Premera Customer Service
Business hours: 7 a.m. to 5 p.m. Monday - Friday