Spine Care

  • Considering spine treatment?

    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 (COE) 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 member of one of these plans: UMP Classic, UMP Select, UMP Consumer-Directed Health Plan (CDHP), UMP Achieve 1, UMP Achieve 2, UMP High Deductible

    AND:

    • Have a lower-back condition that could require surgery
    • Decide on spine care evaluation and treatment from specially chosen physicians at Virginia Mason (Seattle).

    Note: For UMP CDHP and UMP High Deductible members, the evaluation, surgery, and related services are covered in full after you meet your 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 UMP plan benefits. However, the COE Program offers 100% coverage (for UMP CDHP and UMP High Deductible members, after the deductible is met) for:

    • Evaluation of your spine condition and determination of appropriate treatment plans.
    • Lumbar fusion surgery, when it is the right option, at the COE Virginia Mason Medical Center. This facility was chosen because of their proven ability to perform successful spine care treatment with the best results for their patients.

    Eligibility to receive care through the COE Program

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

    • 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.

    Note: The COE Program is not available to UMP Plus members or to members who have Medicare as their primary coverage.

    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 under your UMP benefits)
    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 after discharge from the hospital No
    Post-surgical assessments Yes Follow-up care other than initial post-operative checkup at Virginia Mason COE No
    Post-surgery physical therapy visit (in-hospital) Yes    
    Travel coverage Yes    

     

    Centers of Excellence for Spine Care

      Virginia Mason Medical Center
    Location 1100 Ninth Avenue
    Seattle WA
    Hospital size (licensed beds) 336
    Distance from Sea-Tac Airport 15 miles
    Lodging Inn at Virginia Mason
    1006 Spring St.
    Seattle WA

    The Baroness Hotel
    1005 Spring St.
    Seattle WA
    Lodging distance from hospital Located adjacent to hospital
    Parking at hospital Yes, in parking garage
    Other Virginia Mason is located in Seattle’s First Hill neighborhood, a residential neighborhood and a short walk from downtown Seattle shopping.