Spine care

The Centers of Excellence (COE) Program covers spine care evaluation and/or surgery at low to no cost to qualifying Uniform Medical Plan (UMP) Classic and UMP CDHP members.

Premera Blue Cross administers the COE Program for UMP. For more information about the COE Program, call Premera at 1-855-784-4563  (TRS: 711).

Note: The spine care benefit will be offered to eligible UMP Classic and UMP CDHP members starting January 1, 2019.

Am I eligible?

The spine care COE Program is open to UMP Classic and UMP CDHP members who:

  • Are 18 years or older;
  • Are not enrolled in Medicare as their primary coverage; and
  • Have had more than 12 weeks of lower back or leg pain. The pain must be of confirmed spinal origin with neurologic symptoms or signs. 

Members with the following back conditions do not qualify for the COE Program, although they may need surgery for the spine:

  • Spinal trauma, osteoporotic fracture, tumor, infection, inflammatory conditions, and scoliosis.

HCA has chosen Capital Medical Center (in Olympia) and Virginia Mason (in Seattle) as the COEs for spine care. Capital Medical Center or Virginia Mason must determine if the COE Program is appropriate for you based on established medical guidelines for spine care.

Note: The COE Program is not available to members enrolled in Medicare as their primary coverage or UMP Plus members. Medicare and UMP Plus members still have access to covered services related to spine care outside of this program. These services may be paid at the standard rate.

How much does this benefit cost?

For UMP Classic members, treatment under the COE Program is covered in full. For UMP CDHP members, treatment is covered in full after they meet their annual medical deductible.

To learn about your cost share for this benefit, read the "Spine care" section in your UMP Classic or UMP CDHP certificate of coverage.

If you live more than 60 driving miles from the COE location, you may qualify for assistance with travel and lodging expenses. To be covered, all travel arrangements must be made through Premera.

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 selected by Premera.

How do I get started?

Note: The spine care benefit will be offered to eligible UMP Classic and UMP CDHP members starting January 1, 2019.

If you are interested in participating in the COE Program, you may refer yourself, or your regular provider may refer you, by calling Premera at 1-855-784-4563 (TRS: 711).

Once referred, Premera will determine if you are qualified for the COE Program. If you are, Premera will connect you to your preferred provider, Capital Medical Center or Virginia Mason, for further assessment. Premera will assist you in gathering your medical records so that the clinical team at your chosen COE can make a determination if the COE Program is right for you.

Next, you will meet with the provider to discuss their clinical team’s evaluation of your spine care needs. The clinical team may determine that surgery is not an appropriate treatment for you and provide an alternative treatment plan.

If surgery is appropriate, Premera will work with you to schedule the surgery. You may be required to follow a plan Capital Medical Center or Virginia Mason gives you as a condition of approval for treatment.

Call Premera for more information about the program's clinical review requirements.

Contact

Premera Customer Service
Phone: 1-855-784-4563 (TRS: 711)
Business hours: 7 a.m. to 5 p.m. Monday - Friday