Center of Excellence at Virginia Mason

Center of Excellence coverage is only offered through select employers. Please contact your employer’s Human Resources or Benefits department to see if this program is available. A referral is required from your employer’s third-party administrator in order to confirm coverage for this program. At this time, it is not offered on an individual basis without an authorized Center of Excellence referral from your employer's contracted TPA.

A TPA stands for Third Party Administrator. Within the Center of Excellence Program, the TPAs provide the health plan coverages associated with your employer. In some cases, they act as a temporary insurance company for a set of services to treat a clinical condition or procedure. They may also provide a temporary insurance card for that set of services. For example, if a patient needs a total knee replacement, covered services may include pre-operative and post-operative appointments, imaging, labs, the surgery itself, and your hospital stay. All medical coverages vary by employer. Additional coverages also vary but may include coordination and expenses related to travel, lodging, food and more. If your employer offers a Center of Excellence program, the Human Resources or Benefits department will connect you with their contracted TPA.

The first step is to contact your employer’s Human Resources or Benefits department to see if this program is available to start the referral process.

Once your referral has been received by the appropriate department at Virginia Mason, you will receive a Welcome Call from a Virginia Mason team member within 1-2 business days. At that time, they can provide additional details about next steps specific to their department.

Once all necessary records have been received, the surgeon will determine if evaluation appointments are necessary first, or if we can proceed with scheduling surgery. We will work with you to coordinate all necessary appointments or surgery and submit a plan of care to your employer’s third-party administrator (TPA). 

Your TPA will then reach out to you directly to coordinate appropriate travel arrangements for your visit.

Prior to travel, Virginia Mason will work with your home provider to communicate preoperative and postoperative requirements (if applicable).

During your visit, you will meet with your care team for a comprehensive evaluation to ensure all treatment options are considered. If surgery has been recommended, you will learn more about the surgery including what to expect the day of your surgery and what to expect after surgery. You will also have opportunities to ask questions and our team will be readily available to answer them. We will help you understand what steps you can take to ensure your life is as pain-free as possible after you leave us.

If no changes have been made to your surgery after your evaluation visit, you will proceed with surgery as planned. If any changes to your plan occur, we will discuss it with you in detail and communicate the new plan to your TPA.

Before traveling home, you will typically meet with your care team once more to confirm you are clear to travel. After arriving home, Virginia Mason will contact you periodically to see how you are healing.

All records will be forwarded to your home provider after your visit for any follow up needs. If our provider recommends against surgery after your evaluation visit, an alternative treatment plan will be communicated to you and your home physician.

There are cases where more than one provider is approved to provide care for Center of Excellence patients. This will depend on employer coverage, the department, and the surgeon’s specialty. Once your referral has been received by the appropriate department, you will receive a call from a Virginia Mason team member who can assist with additional information and a list of providers to choose from (if applicable).

There are several factors that can affect the date of your surgery which includes (but is not limited to): the department, type of surgery, procedure duration, medical urgency, and availability. In some cases, an evaluation or several pre-requisite appointments are needed before surgery can be recommended or scheduled. There are also instances when your surgeon may not recommend surgery, in which case we will work with your home provider to communicate conservative treatment recommendations. Once your referral has been received by the appropriate department, you will receive a call from a Virginia Mason team member who can assist with additional information.

The majority of Center of Excellence coverages only offer in-person evaluations. This is to ensure our providers have the opportunity to give you a detailed exam and provide expert recommendation. During your initial welcome call with Virginia Mason, our team can provide further information. 

At this time, all in-person evaluations and surgical procedures are located at our downtown Seattle campus.

Once your appointments or surgery has been scheduled, Virginia Mason will provide the dates of travel to the Third-Party Administrator (TPA) associated with your employer. Travel expenses and accommodation coverage varies by employer, but all travel logistics are coordinated by your TPA. Your TPA’s contact information will be provided to you during your benefits enrollment, during the initial intake process, or by contacting your Human Resources or Benefits department.

All records will be forwarded to your home provider for follow up care management. If a provider recommends against surgery, an alternative treatment plan will be communicated to you and your home physician. If surgery was completed, Virginia Mason will contact you at regular intervals to see how you are healing.