Frequently Asked Questions

The COE Program contracts with providers who have proven their ability to deliver exceptional service and the best outcomes for patients with certain medical conditions. Eligible members who meet medical and other criteria can receive their treatment at low to no cost. This benefit is only available when covered services are received at the COE. For knee and hip replacement, the COE is Virginia Mason Medical Center (Seattle).

This program is open to members of these plans: UMP Classic, UMP Select, UMP Consumer-Directed Health Plan (CDHP), UMP Achieve 1, UMP Achieve 2, UMP High Deductible.

Eligible members:

• Are 18 years or older
• Have been diagnosed with osteoarthritis or another disabling condition that requires a knee or hip total joint replacement

Note: The COE Program is not available to UMP Plus members or UMP Classic members with Medicare as their primary health coverage.

Virginia Mason Medical Center must also determine that surgery for joint replacement is appropriate based on established medical guidelines.

Premera Blue Cross (Premera) administers the COE Program, and medical services are provided through Virginia Mason Medical Center.

A Virginia Mason Medical Center doctor will first assess whether your condition is appropriate for services under the Program.

If you're not eligible or choose not to participate in the COE Program, you may have other benefits for knee and hip replacement under your UMP or Medicare plan.

Participants in the COE Program for total joint replacement must receive care at Virginia Mason. Providers outside of Virginia Mason may be covered under your UMP benefits.

For UMP Classic, UMP Select, UMP Achieve 1, and UMP Achieve 2 members, the surgery and related services are covered in full.

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

Your COE provider may give you a plan to follow before you can be approved for surgery. This could include help for tobacco cessation or weight loss, for example. These medical services may be covered under your UMP benefits (subject to deductible, coinsurance, and copays).

Medically necessary services you receive when you get home from surgery, such as visits with your regular health care provider and physical therapist, also may be covered under your normal UMP benefits (subject to your deductible, coinsurance, and copays).

Premera Blue Cross administers the COE Program, while Regence BlueShield administers your other UMP benefits. Covered, medically necessary services received under the COE Program for joint replacement may only be provided at Virginia Mason Medical Center or MultiCare Capital Medical Center.

Premera may be able to help COE Program participants reduce out-of-pocket travel expenses.

Members who otherwise meet criteria for a knee or hip replacement may qualify for assistance with travel, lodging, and car service expenses. These expenses may include reimbursement from Premera for mileage. Our concierge service representatives can help find the best travel options for you.

In general, members qualify for travel assistance if they live more than 60 driving miles from Virginia Mason (1100 9th Ave., Seattle). Premera will work with you to determine which travel benefits are covered and to schedule travel details.

Find out more about the Program's travel benefit.

A care companion is a family member or friend who will care for you before and after your surgery. This person should be:

• At least 18 years of age with a valid driver’s license;
• Mentally aware and capable of following care instructions;
• Physically capable of bending, lifting, squatting, and walking approximately two blocks; and
• Able to dedicate time toward your recovery, including staying in the hospital during surgery and recovery and dedicating at least a week of in-home care for you after surgery.

Find out more about the Program's travel benefit.

Your regular health care provider can refer you to the COE Program, or you may contact Premera at 855-784-4563 (TRS: 711). If you are already seeing a Virginia Mason provider, they can also refer you.

Premera representatives will first determine if you qualify for the Program. Then, Virginia Mason surgeons will review your medical records and discuss with you whether surgery is the right option at this time.

You can send your appeal within 180 days after you receive notice of the denial to:

Premera Blue Cross
ATTN: Appeals Department
MS 123
PO Box 91102
Seattle, WA 98111-9102

You may also fax us at 800-995-2430 (secure inbound fax).