Centers of Excellence

Centers of Excellence are designated facilities proven to deliver superior results for complicated, costly surgical procedures.

Using a Center of Excellence could improve your outcome and reduce your cost if you have a serious surgery coming up. Centers of Excellence are designated hospitals, providers, or groups that meet high quality and cost standards for complicated, costly surgical procedures.

Based on evidence-based objective criteria, the Center of Excellence designation helps you identify facilities that offer quality specialty care for bariatric surgery, cancer, cardiac care, knee and hip replacements, maternity, spinal surgery, and transplants.

Overall, patients treated at Centers of Excellence have

  • better outcomes;
  • fewer complications;
  • fewer readmissions; and
  • lower total cost of care.

Centers of Excellence specialty care benefits

If you’re enrolled in the PPO, EPO, or HDHP, your coverage includes Centers of Excellence specialty care benefits.* When you or your covered family members have the following select procedures performed at a Center of Excellence, the plan will pay 100 percent of allowable charges after the annual plan deductible is met:

Bariatric surgery

  • Roux-en-Y gastric bypass
  • vertical banded gastroplasty
  • biliopancreatic bypass
  • biliopancreatic bypass with duodenal switch
  • adjustable gastric banding
  • gastric sleeve resection
  • revision of gastric restrictive procedures

Knee and hip replacements

  • total knee replacements
  • total hip replacements

Transplants

  • heart
  • lung (deceased and living donor)
  • combination heart/lung
  • liver (deceased and living donor)
  • simultaneous pancreas kidney (SPK)
  • pancreas (PAK/PTA)
  • bone marrow/stem cell (autologous and allogenic)

Spinal surgery

  • discectomy
  • fusion
  • decompression procedures

In addition, patients who must travel more than 100 miles to a Center of Excellence are eligible for a travel benefit of up to $10,000 to cover expenses for themselves and a companion.

Find a Center of Excellence

You can locate Centers of Excellence online or by calling your service provider.

  • If you use the national Blue Cross Blue Shield Network – Centers of Excellence are designated as Blue Distinction Centers and Blue Distinction Centers +. Use the provider search tool on the Highmark website to find providers with these designations. From the home page, click on Find a Doctor or Pharmacy and select Find a Doctor, Hospital or other Medical Provider; then scroll down, click on Blue Distinction Centers under Find Quality Care, and search by desired specialty and state. Or, call the number on the back of your medical ID card.
  • If you use the Aetna network – Aetna Institutes of Quality (bariatric surgery, knee and hip replacements, and spinal surgery) and Aetna Institutes of Excellence (transplants) are Centers of Excellence. To find facilities with these designations, call the number on the back of your medical ID card, or visit the Aetna website to use the provider search tool.

*Centers of Excellence specialty benefits are not available to members enrolled in Triple-S, GeoBlue, or the Medicare Supplement Plan.