A total knee or hip joint replacement procedure can be expensive. Insured patients can expect to pay out-of-pocket costs of several thousand dollars, typically up to their annual out-of-pocket maximum. Under the WTIA Association Health Plan (AHP), for example, maximum out-of-pocket costs can range from $1,500 for an individual to $12,700 for a family. Without health insurance, a total hip replacement may cost, on average, around $33,000; for knee replacement surgery, that expense is about $35,000, depending on the medical facility where the procedure is done. 

Additionally, not all medical facilities are created equal. Some charge a premium for these replacement surgeries, while others offer discounts, mostly for uninsured patients. And the quality of care and cost may vary depending on the center delivering treatment, its staff, and location. 

That’s why WTIA and Premera consistently work on our members’ behalf to deliver better service excellence and quality outcomes for these services. To accomplish this, Premera has partnered with providers—called Designated Centers of Excellence—that have agreed to be held accountable for care quality, experience and cost. Dedicated Centers of Excellence provide high-quality care for complex medical situations, and typically offer lower out-of-pocket costs for total knee or hip joint replacement services. Premera chose these surgeries specifically because they are among the most commonly performed procedures. 

Premera Dedicated Centers of Excellence** take the guesswork and headaches out of finding high-quality care for your employees. This program delivers:

• A predictable, bundled cost for:
  • Pre-surgical consultations and related procedures
  • Hospitalization, surgery and related in-patient care
  • Post-surgical checkups
• Lower out-of-pocket costs: Co-pays, coinsurance and deductibles are waived, except for the qualified high-deductible health plan (HDHP) deductible. That way, your employees can focus on healing without worrying about costly medical bills.
• Personalized support: Experts are available to help coordinate care, schedule appointments, and make pre-paid travel arrangements for your employees. 
• Travel benefits: These include air travel and ground transportation from airport to hotel for your employee and a companion. Lodging (up to IRS limits) is available to members living more than 50 miles away from a Premera Designated Centers of Excellence facility.   

**Available to WTIA health plan members who are on the Heritage Network. Does not include the Heritage Prime Network. 

The Designated Centers of Excellence for total knee and hip joint replacement are: 

• Swedish First Hill, Seattle and Ballard 
• Swedish Edmonds, Edmonds 
• Providence St. Peter Hospital, Olympia 
• Providence Regional Medical Center, Everett 
• Kadlec Regional Medical Center, Benton County 
• Providence Sacred Heart Medical Center, Spokane

All seven facilities meet certain clinical criteria, including adhering to Bree Collaborative guidelines, to improve patient health outcomes. The Dr. Robert Bree Collaborative was established by the Washington State Legislature in 2011 to provide public and private healthcare stakeholders an opportunity to identify specific ways to improve healthcare quality, outcomes, and affordability statewide. Stakeholders are appointed by the Washington State governor as Collaborative members. These stakeholders represent public health care purchasers for Washington State, private health care purchasers (employers and union trusts), health plans, physicians and other health care providers, hospitals, and quality improvement organizations. Each year, Bree Collaborative stakeholders identify healthcare services with less-than-optimal care and patient outcomes and work together to identify and promote strategies to improve healthcare outcomes, quality, equity and affordability.

Most medical insurance benefits just renewed with the new calendar year, resetting deductibles and out-of-pocket maximums. If you have employees who need knee or hip joint replacement, have them consider utilizing this benefit for those procedures. This will decrease their out-of-pocket expenses overall with the reset of their benefits. Simply put, choosing a Designated Center of Excellence can help your employees get the high-quality care they need with less stress, and at an affordable price. 

Have questions or want to learn more about Premera’s Designated Centers of Excellence? Contact your broker, or the WTIA Benefits Team at hrbenefits@watech.org.