Centers of Excellence
Centers of Excellence are designated facilities proven to deliver superior results for complicated, costly surgical procedures.
Using a Center of Excellence could improve your outcome and reduce your cost if you have a serious surgery coming up. Centers of Excellence are designated hospitals that meet high-quality and cost standards for complicated, costly surgical procedures.
Based on evidence-based objective criteria, the Center of Excellence designation helps you identify facilities that offer quality specialty care for bariatric surgery, cancer, cardiac care, knee and hip replacements, maternity, spinal surgery, and transplants.
Overall, patients treated at Centers of Excellence have
- better outcomes;
- fewer complications;
- fewer readmissions; and
- lower total cost of care.
In addition, patients who must travel more than 100 miles to a Center of Excellence are eligible for a travel benefit of up to $10,000 to cover expenses for themselves and a companion.
Centers of Excellence specialty care benefits
If you’re enrolled in the PPO, EPO, or HDHP, your coverage includes Centers of Excellence specialty care benefits.* When you or your covered family members have the following select procedures performed at a Center of Excellence, the plan will pay 100% of allowable facility charges after the annual plan deductible is met:
Bariatric surgery
- Roux-en-Y gastric bypass
- vertical banded gastroplasty
- biliopancreatic bypass
- biliopancreatic bypass with duodenal switch
- adjustable gastric banding
- gastric sleeve resection
- revision of gastric restrictive procedures
Knee and hip replacements
- total knee replacements
- total hip replacements
Transplants
- heart
- lung (deceased and living donor)
- combination heart/lung
- liver (deceased and living donor)
- simultaneous pancreas kidney (SPK)
- pancreas (PAK/PTA)
- bone marrow/stem cell (autologous and allogenic)
Spinal surgery
- discectomy
- fusion
- decompression procedures
Find a Center of Excellence
You can locate Centers of Excellence online or by calling Quantum Health. The number is on the back of your medical ID card.
Centers of Excellence are designated as Blue Distinction Centers and Blue Distinction Centers +. To find facilities with these designations, log on to the Quantum Health website and click My Plan then CARE FINDER to use the online provider search tool, or call Quantum Health at 855-497-1237 and a Care Coordinator will help you find a Center of Excellence.
Note: Having the Blue Distinction Center or Blue Distinction Center + designation does not mean that a facility is a Center of Excellence for all types of procedures. For example, a facility may be a Center of Excellence for knee and hip replacements but not for spinal surgery. To qualify for Centers of Excellence specialty care benefits, your procedure must be done at a facility that is a designated Center of Excellence for that particular procedure. You can check this online or by calling Quantum Health.
*Centers of Excellence specialty benefits are not available to retired members with medical coverage through the Board of Pensions or those enrolled in Triple-S or GeoBlue.