Joint Replacement Program
The State Health Plan is working with select high-quality orthopedic specialists to offer a joint replacement program for eligible employees in need of knee, hip or shoulder replacement surgery. The program simplifies the entire process with one simple payment.
The costs and services related to the joint replacement surgery will be billed together eliminating the hassles of multiple billing statements, which is often referred to as a bundled payment.
If member is deemed eligible for the program, by one of the participating providers below, they may be eligible for a single copay instead having their deductible and coinsurance applied to their surgery!
If a member is eligible, there will be no deductible or coinsurance applied to bundled services. Instead, a member will only be responsible for paying a copay.
- Enhanced PPO Plan (80/20) – Member only pays a $600.00 copay
- Base PPO Plan (70/30) – Member only pays a $900.00 copay
The bundled payment includes the cost of the following medical charges:
- Orthopedic surgeon visits
- Hospital or surgical facility care
- Anesthesia
- Physical Therapy visits
- Emergency Room visits related to your surgery
Participating providers have agreed to coordinate care and billing related to a total knee, hip or shoulder replacement. Below is a list of participating providers:
- Surgical Center of Greensboro
- OrthoCarolina
- EmergeOrtho PA
- Surgical Center of Pinehurst
- Raleigh Bone and Joint
Contact Aetna at 833-690-1037 for additional participating provider information.