Knee and Hip Replacement

  • Knee or hip total joint replacement is a big decision that requires working closely with your regular health care provider. If the right move is surgery, we want you to have the information you need to make an empowered decision on where you go for care.

    A guide to your benefit through Premera Blue Cross

    Premera is focused on helping each patient have a great treatment experience. We offer concierge service with specially trained, experienced representatives to help guide you through your care.

    You may receive treatment at low to no cost to you if you:

    • Are a member of these plans: UMP Achieve 1, UMP Achieve 2, UMP Classic, UMP CDHP, UMP High Deductible
    • Decide on single knee or single hip total joint replacement surgery with specially chosen doctors at Virginia Mason (Seattle)

    Note: For UMP CDHP and UMP High Deductible members, the surgery and related services are covered in full after you meet your annual medical deductible.

    We recognize you have many options for knee or hip replacement. You may still receive joint replacement through other providers under your UMP plan. However, the COE Program offers you 100% coverage (minus the deductible for UMP CDHP and UMP High Deductible members) for your joint replacement. If you qualify, the COE Program will also assist with travel and lodging expenses for you and a care companion*.

    Qualifying for care

    To help ensure that surgery is needed, and to encourage the smoothest recovery, knee or hip replacement surgery is recommended only for members who:

    • Are 18 or older
    • Do not have Medicare as their primary coverage
    • Have been diagnosed with osteoarthritis or another disabling condition that requires a single knee or single hip total joint replacement

    Note: The COE Program is not available to UMP Plus members.

    To help ensure your safety and the best surgical results, the COE Program has pre-surgery requirements. These include:

    • Having a body mass index (BMI) of less than 40
    • Avoiding smoking for 4 weeks prior to surgery
    • Maintaining a hemoglobin A1c level of less than 8% in patients who have diabetes

    Read more about our surgery preparation and recovery guidelines.

    COE Program highlights

    What’s covered What’s NOT covered
    (but may be covered under your UMP benefits)
    Pre-operative services (office visit, laboratory work, x-ray) Yes

    Care received under your Virginia Mason prescribed plan for care that's necessary to become a surgical candidate under the COE Program

    No
    Hospitalization and surgery, including anesthesia Yes

    Physical therapy  that's not provided during your hospitalization

    No

    Post-surgical assessments

    Yes Medications prescribed upon discharge from the hospital No
    Post-surgery physical therapy visit (in hospital) Yes Follow-up care other than the initial post-operative checkup at Virginia Mason No
    Travel coverage Yes    

    Questions?

    Call our concierge desk at 855-784-4563 (TRS: 711).

    You can find out more about your knee and hip replacement benefits through your UMP coverage.

    *A care companion is a family member or friend who will care for you before and after your surgery. The concierge team will explain what is required for a person to be designated as care companion.