Welcome, City and School Employees, to the Brain & Spine Network Center of Excellence.
We are excited you are a part of the program and look forward to participating in your health care journey. This program is a benefit to you and your covered dependents provided by your employer.
All school consortium employees who participate in the health insurance program and meet the clinical requirements are eligible for this benefit. Spouses and dependents who meet the clinical requirements are also eligible for this benefit. Dependents must be 18 years of age or older. If the patient meets the clinical requirements and is eligible for the program, there will be no out of pocket expense for the member. Your employer has waved all co-pays and deductibles. The COE physician will determine clinical eligibility. Any services that do not meet the clinical requirements will be billed to the member’s primary insurance, and the member will be responsible for co-pays and deductibles.
IMPORTANT: Employees who have a government-sponsored health care plan as a secondary insurance are not eligible for the Center of Excellence program. This includes Tri-Care, Medicare and Medicaid plans. This exception is based on an IRS ruling.
- The following are examples of procedures and evaluations that may be covered as a part of this program:
- Conservative Care Management
- Surgical Evaluations (Cranial and Spine) – Members who are recommended for surgery must have the procedure within 180 days of the evaluation or be required to complete a second evaluation
- Interventional Pain management
- Physical therapy
- Advanced Imaging (CT, MRI)
- To access this benefit, an employee, their spouse or dependent must contact the COE Navigation Team at 901-227-8927. The COE Navigator will provide assistance and guidance throughout these services. Employees who obtain care with one of the care team, but do not enroll through the navigator, will not be eligible for this program.
PLEASE NOTE THAT NOT ALL NEUROLOGICAL AND NEUROSURGICAL PROCEDURES OR SERVICES ARE INCLUDED IN THIS PROGRAM.
Frequently Asked Questions
HOW DO I ENROLL IN THIS PROGRAM?
To participate in the COE program, the member must contact the Nurse Navigator prior to scheduling any services at any of the Brain & Spine Network locations. Any services that occur prior to enrollment with the navigator will not be eligible for coverage and will be billed to your primary insurance.
WILL I BE CHARGED FOR ANY SERVICES PROVIDED THROUGH THE CENTER OF EXCELLENCE?
If the patient meets the clinical requirements and is eligible for the program, there are no out of pocket expenses. The COE physician will determine clinical eligibility. Any services that do not meet the clinical requirements will be billed to the member’s primary insurance, and the member will be responsible for co-pays and deductibles.
IS MY SPOUSE COVERED BY THE PROGRAM?
If they are covered by your health plan, then yes: Your spouse and any eligible dependents 18 or older also qualify for the Center of Excellence program.
HOW DO I QUALIFY FOR THESE SERVICES?
Employees who participate in the employer’s health plan qualify for the Center of Excellence program. If you are eligible, your spouse and any eligible dependents, 18 years or older, also qualify. A provider will determine your clinical eligibility for the Center of Excellence services during your initial evaluation.
I HAVE A QUESTION ABOUT THE CENTER OF EXCELLENCE THAT IS NOT ANSWERED HERE. HOW CAN I GET MORE INFORMATION?
We are happy to answer your questions! Contact the Center of Excellence by calling 901-227-8927, Monday through Friday, 8:00 a.m. - 4:00 p.m.