What happens if I've already started the process elsewhere?
If you have already been pre-approved and decided to have surgery elsewhere but would like to use your Centers of Excellence benefit through The Christ Hospital (TCH), you will need to change to one of the Centers of Excellence physicians. Please contact a member of the Western & Southern Managed Care Team at 513-629-1400 or 800-333-1455 to see if you qualify for the program and to obtain additional information:
Once you have entered the program, a Christ Hospital Navigator will reach out to you to assist with setting up an appointment with one of the Centers of Excellence physicians.
What is covered in the program?
The program covers:
- The initial orthopedic consult, if surgery is indicated
- Preadmission testing at a Christ Hospital Health Network facility
- History & physical examination by a Christ Hospital provider. Please note: Patients traveling from out of town may use a practitioner at The Christ Hospital for their history & physical when in town if convenient. If you choose to have your history & physical by a provider other than a Christ Hospital provider it will not be covered under the program and normal insurance coverage benefits will apply.
- Your Surgical Procedure and Hospital Stay
- Durable Medical Equipment ordered at discharge by your surgeon
- Post-operative care related to the surgery for 90 days following surgery IF care is performed at a Christ Hospital facility and by a Christ Hospital provider.
Is post discharge therapy included in the program?
No, post discharge therapy is not covered as part of the Center of Excellence program, but is covered under your health insurance plan. You may call the Western & Southern Benefits
Department at 513-629-1400 or 1-800-333-1455 to obtain information about post
discharge therapy locations and benefits.
If I do not meet the exclusion criteria, can I still have surgery?
includes, but is not limited to: a potential patient with a Body Mass Index
(BMI) >40 (you can determine your BMI by referencing the chart in your Western
& Southern Summary Plan Description) or weight > 350 pounds; glycohemoglobin A1c estimated average
glucose result greater than or equal to eight (8). For additional exclusion details,
please contact a member of the Western & Southern Managed Care team.
You may still be able to have surgery even if you do not meet the exclusion criteria, however you will not receive this enhanced Center of Excellence benefit. If you do not meet the exclusion criteria at this time but you and your surgeon elect to proceed with surgery outside of the Centers of Excellence program, your normal health plan benefits will apply and will be subject to any plan deductibles, co-pays or coinsurance. Your surgeon will specifically discuss the necessity and safety of a surgical procedure with you.
Does everything need to be done at a TCH facility or by a TCH provider to be included in the program?
Yes, in order to receive the benefits of the Centers of Excellence program, all care must be received at a Christ Hospital facility and done by a Christ Hospital provider.
What states are covered by the Center of Excellence program?
The Center of Excellence program benefits are available to employees in the followinging states:
- New Jersey
- New York
- North Carolina
- South Carolina
- Washington DC
- West Virginia