Quality

We believe improving quality is the path to delivering value.

MSK surgeries can be costly, and outcomes vary greatly. We also know provider quality can be hard to find. That’s why we selected the highest quality, most cost-efficient providers for hips, knees and spinal surgeries based on internal and third-party quality data. This helps members achieve better care, cost savings, and a streamlined surgical journey.

Features:

Lower-cost surgeries

The Musculoskeletal Centers of Excellence Rider¹ offers lower-cost surgeries at participating Centers of Excellence. Professional and facility fees for eligible surgeries will be $0². Anesthesia fees are subject to deductible and plan coinsurance.

Coverage for facility travel expenses

If members need to travel to a facility that is more than 50 miles from their residence, the embedded travel rider covers IRS eligible travel expenses up to $1,000 per contract year for Covered Services provided by a Priority Health Centers of Excellence Provider.

• Prior Authorization is required
• Travel reimbursement is limited to reasonable expenses for transportation, meals and lodging related to Prior Authorized services³
• Amounts reimbursed for travel expenses do not apply to Member’s Deductible or Out-of-Pocket Limit⁴