The COE Program contracts with providers who have proven their ability to provide 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 Achieve 1, UMP Achieve 2, UMP Classic, UMP CDHP, UMP High Deductible.
Note: The COE Program is not available to UMP Plus members or UMP Classic members with Medicare as their primary health coverage.
Virginia Mason 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 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 Achieve 1, UMP Achieve 2, and UMP Classic 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 medical 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 cost share (subject to 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.
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:
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 of a denial to:
Premera Blue Cross
ATTN: Appeals Department
PO Box 91102
Seattle, WA 98111-9102
You may also fax us at 800-995-2430 (secure inbound fax).
For questions about, or to apply for, the COE Program:
Premera Concierge Desk
855-784-4563 (TRS: 711)
Weekdays, 7 a.m. to 5 p.m. Pacific Time
For questions about UMP benefits:
UMP Customer Service
888-849-3681 (TRS: 711)
Weekdays, 5 a.m. to 8 p.m. Pacific Time
Saturdays, 8 a.m. to 4:30 p.m. Pacific Time
For more information, visit the UMP site.
Washington State Rx Services888-361-1611 (TRS: 711)
24 hours a day, 7 days a week
Learn about surgery preparation and guidelines.