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Surgery Care Benefit (Transcarent)

Surgery Care Benefit (Transcarent)

Save money and get access to top-rated hospitals, surgery centers and surgeons nationwide for planned, non-emergency procedures with Transcarent.

Eligibility

If you are enrolled in an Anthem (BCBS) or UHC medical option, you and your covered dependents have access to this benefit – at no cost.

How It Works

If your doctor recommends surgery, call Transcarent at 1-877-820-7992 before you schedule the procedure. Transcarent partners with providers that achieve high-quality ratings for low complications, infection and readmission.

Support from a Transcarent Coordinator

A Transcarent Coordinator will help you select a top-rated provider for your specific procedure and handle the administrative work, approvals, billing and scheduling. If travel is required, your Transcarent Coordinator will arrange transportation and lodging for the patient and a companion.

Benefits

Covered Procedures

Here are some commonly covered procedures from Transcarent:

General: Gall bladder removal, hernia repair
Cardiac: Coronary artery bypass graft, valve repair and replacement
Orthopedic: ACL repair, hip and knee replacement, shoulder repair and replacement
Spine: Spinal fusion, artificial disc replacement
Women’s health: Hysterectomy
Other covered procedures: Certain vascular, bariatric and neurological procedures

Certain procedures are not covered.

Emergency, pediatric (under age 13), cosmetic, dental, diagnostic, vision and transplant procedures are not covered.

Coverage and Payment

Coverage and payment for Transcarent depend on which medical plan you are enrolled in:

PPO or EPO: Surgery is covered 100%.
HDHP w/ HSA or HDHP Basic: Surgery through Transcarent is covered 100% after you meet your deductible. Transcarent coordinates with your health plan to verify your remaining deductible amount prior to surgery. A credit card is required to pay the deductible balance.

Surgery Expenses

Covered surgery costs include:

Pre-operative surgeon appointment
All facility, anesthesia, surgical staff and surgeon charges
In-patient services, if hospital stay is required
Post-operative surgeon appointment

Learn about pre- and post-operative costs.

Medical expenses that occur before the pre-operative appointment and after the post-operative appointment are covered under the UNFI medical program and subject to plan coverage guidelines, deductible and coinsurance.

Travel Expenses

If a local surgeon isn’t available and travel over 100 miles (one way) is required, Transcarent pays patient and companion expenses for:

Airfare (coach unless first class is medically necessary)
Lodging (one double-occupancy room)
Meals and incidentals allowance
- $50 per day for the patient when not admitted (days 1-14)
- $50 per day for a companion (days 1-14)
- $125 per week per person (days 15+)

Airfare and lodging must be arranged by your Transcarent Care Coordinator for coverage. A travel companion is required and must be at least 18 years of age. You’ll receive a pre-paid debit card for meals and incidentals a few days before your surgery.