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 spine care, 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, and who:

• Are 18 years or older.

• Have low-back pain or leg pain coming from the spine for more than 12 weeks, which might qualify for surgical treatment. Certain causes for low-back pain, including spinal trauma, osteoporotic fracture, tumor, infection, inflammatory conditions, and scoliosis, are not covered under the COE.

To be eligible for this low to no cost treatment, Virginia Mason Medical Center must also determine if surgery for spine care is appropriate, based on established medical guidelines.

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

Medical services are provided through Virginia Mason Medical Center (Seattle).

A team of providers at your COE, including a surgeon, will assess whether your condition is appropriate for surgery under the program.

If you're not eligible or choose not to participate in the COE Program, you may have other benefits for spine care under your UMP or Medicare benefits.

Participants in the COE Program for spine care must receive care at Virginia Mason. Other providers may be covered under your UMP benefits.

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

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

Your team of providers 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 normal UMP benefits (subject to your deductible, coinsurance, and copays).

Medically necessary services you receive when you get home from the evaluation or surgery, such as visits with your regular health care provider and physical therapist, may be covered under your 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 may only be provided at Virginia Mason Medical Center.

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

Members who otherwise meet criteria for a qualified evaluation and surgery may be eligible 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 COE. 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 healthcare provider can refer you to the COE Program, or you may contact Premera at 855-784-4563 (TRS: 711).

Premera representatives will first determine if you are eligible for the program. Once referred to a COE, a team of providers, including a surgeon, will review your medical records. They will then discuss with you whether surgery is the right option at this time, and make a plan with you for next steps in care.

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).