Nebraska Centers of Excellence

 

Beginning January 1, 2019, Blue Cross Blue Shield Nebraska (BCBSNE) will waive deductible and coinsurance for the surgical facility charges for total knee or hip replacement surgeries performed at one of the Nebraska Centers of Excellence below.

 

We believe in helping you receive affordable, high-quality care. As part of our commitment to you, we have established Nebraska Centers of Excellence across the state for total knee or hip replacement surgeries resulting in significant cost savings to you.

 

These facilities have met or exceeded our high quality of care and costs standards.

 

Kearney

Kearney Regional Medical Center - Kearney Regional Medical Center offers diagnostic and therapeutic services covering the spectrum of medical and surgical specialties.

804 22nd Avenue, Kearney, NE

(308) 455-3600

 

Lincoln

Lincoln Surgical Hospital - Founded in 1994, 11,000 surgeries a year are performed at this physician-owned facility. Lincoln Surgical Hospital ranks among 250 surgical specialty hospitals in the United States and is the only multi-specialty hospital in Nebraska.

1710 S. 70th Street, Lincoln, NE
(402) 484-9090

 

Omaha

OrthoNebraska Hospital - Formerly known as Nebraska Orthopaedic Hospital upon its opening in April 2004, OrthoNebraska is the region’s first hospital dedicated to the complete care and treatment of the orthopedic patient. The hospital has recently been named by U.S. News and World Report as the top hospital for orthopedics in Nebraska and was also recognized by the publication as high performing in both the total hip and total knee replacement categories.

2808 S 143rd Plaza, Omaha, NE
(402) 609-1600

 

Midwest Surgical Hospital - Opened in 2008, Midwest Surgical Hospital has been rated as “One of the 82 physician-owned hospitals to know in America,” by Becker’s Hospital Review. The hospital has also received the Edge Survey Apex Quality Award for recognition of excellence in overall patient satisfaction, 2012-2014.

7915 Farnam Drive, Omaha, NE
(402) 399-1900

 

Requirements:

To have the deductible and coinsurance waived, your surgery and health plan must meet the following requirements:

  • Nebraska Center of Excellence must be in-network for your plan
  • Only inpatient total knee or hip replacement surgeries qualify for this benefit
  • Facility approves your surgery (higher risk patients maybe referred to another facility)

Please note, if you have a qualified high-deductible health plan, only coinsurance will be waived if all other requirements are met.

 

Frequently Asked Questions

 

What is a Center of Excellence?

A Nebraska Center of Excellence is a surgical facility that has demonstrated high-quality through low readmission and infection rates, high patient satisfaction and lower costs for total knee and hip replacements.

 

What surgical facilities are included in the program?

  • Kearney Regional Medical Center
  • Lincoln Surgical Hospital
  • Midwest Surgical Hospital
  • OrthoNebraska Hospital

 

What requirements need to be met in order to have the deductible and coinsurance waived for the surgical facility?

This program covers inpatient total knee and hip replacement surgeries only at an in-network Nebraska Center of Excellence. Deductibles and coinsurance will be waived for PPO plans and coinsurance will be waived on qualified high deductible health plans for the surgical facility charges only. You will be responsible for deductible, coinsurance and copays (if applicable) for all other costs related to your surgery.

 

How are Centers of Excellence different from Blue Distinction providers?

Nebraska Centers of Excellence surgical facilities do not have an ICU and emergency room, both of which are required to qualify as a Blue Distinction Center. The exception is Kearney Regional Medical Center, as it meets requirements for both.

 

What surgeries are covered?

Total knee and hip replacement surgeries are the only procedures covered under the Nebraska Center of Excellence program. All other surgeries will be subject to the terms your health plan.

 

Do the waived deductible and coinsurance amounts apply to other fees like lab work, anesthesiologist, surgeon fees, etc.?

No. We will waive deductible and coinsurance amounts for the approved Nebraska Center of Excellence inpatient surgical facility charges only. You will be responsible for any deductible, coinsurance and copay amounts for the other services related to your surgery.

 

What provider networks does this program apply to?

At this time, this program is available for the plans using NEtwork Blue and Premier Select BlueChoice networks. Members covered under BluePrint health are not eligible for this benefit, as the Nebraska Centers of Excellence are out of network.

 

What if I have met my deductible for the year?

If your deductible has been met for the year, the program will cover any applicable coinsurance amounts for surgical facility charges only.

 

Could the Nebraska Center of Excellence surgical facility refer me to another location my surgery?

Yes. The surgical facility could determine that your health conditions warrant additional safety measures and you would be better managed at another location with an emergency department and/or intensive care unit. If this occurs, standard plan benefits would apply.

 

What if my doctor cannot perform surgery at a Nebraska Center of Excellence facility?

Nebraska Centers of Excellence on this program are open to all doctors. Your doctor would need to contact the facilities to complete the necessary requirements.

 

Will there be a penalty if I do not use a Center of Excellence?

No. You will not be penalized for using another facility. However, you will be responsible for all deductible, coinsurance and copay amounts.

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.