State of Maine Health Insurance Plan incents members to seek bariatric and hip/knee procedures at Centers of Excellence

Effective January 1, 2019, the State of Maine Health Insurance Plan implemented a plan design change to incent members requiring hip and knee replacement and bariatric surgery procedures to receive those services at facilities designated as Centers of Excellence (COE).  Member cost sharing for these procedures at designated facilities will be waived.  Also, a travel benefit is being provided for members who need to travel more than 100 miles from their permanent residence to the COE.

 

To receive COE designation for these procedures, a hospital must have been awarded:

1. Anthem’s Blue Distinction Plus designation, and
2. An overall Leapfrog Safety Grade of “B” or better.

 

The following facilities in Maine have been designated as COEs. 

Bariatric Facilities

• Maine Medical Center
• Central Maine Medical Center
• Eastern Maine Medical Center

 

Procedures

• Gastric banding
• Gastric stapling

 

Knee and Hip Facilities

• Maine Medical Center
• Central Maine Medical Center
• St. Joseph Hospital

 

Procedures

• Knee and hip replacements
• Total knee and hip replacements
• Revision knee and hip replacements