Spine Care

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    Considering spine treatment?

    Your COE spine care benefit starts Jan. 1, 2019.

    If you’ve been suffering with back pain for a long time then you may be wondering whether surgery would be helpful. The Centers of Excellence for Spine Care Program can help you determine whether surgery is the right choice.

    A guide to your benefit through the Centers of Excellence Program

    Premera is focused on helping each member in the COE Program have a great treatment experience. We offer concierge service with experienced representatives to help guide you through your care including a comprehensive evaluation, and if appropriate, surgery and follow-up care.

    You may receive treatment through the COE Program at low to no cost to you if you:

    • Are a UMP Classic or UMP CDHP member
    • Have a lower back condition that could require surgery
    • Decide on spine care evaluation and treatment from specially chosen physicians at Virginia Mason (Seattle) or Capital Medical Center (Olympia).

    Note: UMP CDHP members must first meet their annual deductible.

    We recognize you have many options for spine care evaluation and surgery. You may still receive spine care through other providers using your primary health plan benefits. However, the COE Program offers 100% coverage (less the deductible for CDHP members) for:

    • Evaluation of your spine condition and determination of appropriate treatment plans.
    • Lumbar fusion surgery, when it is the right option, at either of the two COEs: Virginia Mason or Capital Medical Center. These facilities were chosen because of their proven records of performing successful spine care treatment with the best results for their patients.

    Qualifying for care

    To help make sure members get the appropriate care, they must:

    • Not have Medicare as their primary coverage
    • Be 18 years of age or older; 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
    • Scoliosis

    If lumbar fusion surgery is recommended, the COE Program requires the following to ensure candidates’ safety and the best surgical results:

    • A body mass index (BMI) of less than 40
    • No smoking for 4 weeks prior to surgery
    • Maintaining a hemoglobin A1C level of less than 8% in patients who have diabetes

    Read more about the Program's guidelines.

    COE program highlights

    What’s covered What’s NOT covered
    (but may be covered at your typical UMP benefit level)
    Spine care evaluation to determine the appropriate treatment Yes Services necessary to become a surgical candidate under the COE Program (including those received under your plan for care) No
    Pre-operative services (office visit, laboratory work, x-ray) if surgery is recommended Yes Physical therapy that's not provided during your hospitalization No
    Hospitalization and surgery, including anesthesia Yes Medications prescribed upon discharge from the hospital No
    Post-surgical assessments Yes Follow-up care other than the initial post-operative checkup at your selected COE (Virginia Mason or Capital Medical Center) No
    Post-surgery physical therapy visit (in-hospital) Yes    
    Travel coverage Yes    

     

    Centers of Excellence for Spine Care

      Capital Medical Center Virginia Mason Medical Center
    Location 3900 Capital Mall Dr. SW
    Olympia WA
    1100 Ninth Avenue
    Seattle WA
    Hospital size (licensed beds) 110 336
    Distance from Sea-Tac Airport 58 miles 15 miles
    Lodging Red Lion Inn
    2300 Evergreen Park Dr. SW
    Olympia WA
    https://www.redlion.com/olympia
    Inn at Virginia Mason
    1006 Spring St.
    Seattle WA
    http://www.innatvirginiamason.com/

    The Baroness Hotel
    1005 Spring St.
    Seattle WA
    https://www.baronesshotel.com/
    Lodging distance from hospital 2.8 miles (transportation provided) Located adjacent to hospital
    Parking at hospital Yes, in adjacent lot Yes, in parking garage
    Other Capital Medical Center is located in West Olympia with shopping and restaurants nearby and within easy driving distance.

    Downtown Olympia is 3 miles away and features a charming historic district, a mall district, and a waterfront farmers market.
    Virginia Mason is located in Seattle’s First Hill neighborhood, a residential neighborhood and a short walk from downtown Seattle shopping.