This service provides information about Carrum Health, a surgery benefit, and the Carrum Oncology bundle, which consists of Guidance and Treatment services.
Carrum Health is a surgery benefit that delivers an unparalleled experience. Carrum Health provides access to hand-picked surgeons that have lower complications, lower readmissions, and more experience as well as exclusive access to Centers of Excellence for qualified surgeries and a care concierge team that guides you through each step. These facilities and doctors provide for an improved patient experience, high quality of care, and zero or minimal out-of-pocket costs for surgeries and consultations.
Active employees, early retirees, COBRA participants and their dependents on EIA Health Anthem plans are eligible for this program. Watch this video to learn more about Carrum Health!
Which procedures are covered?
Eligible procedures include:
- Total hip and total knee replacement (inpatient and outpatient)
- Other outpatient musculoskeletal procedures:
- Shoulder (e.g., rotator cuff repair)
- Elbow (e.g., fracture repairs)
- Wrist/Hand (e.g., carpal tunnel surgery)
- Hip (e.g., hip arthroscopy)
- Knee (e.g., meniscus and ACL repairs)
- Ankle/Foot (e.g., Achilles tendon repair)
- Outpatient back pain management procedures
- Spinal Procedures (inpatient and outpatient cervical/lumbar spinal fusion, laminectomy, discectomy)
- Bariatric* Weight-Loss Surgery
- Coronary Bypass Surgery
For total join replacement, spinal fusion, and bariatric (weight loss) surgeries, you will be required to have a second opinion evaluation through the Carrum Health Program, prior to scheduling your procedure. If surgery is the right treatment path, you may continue through Carrum Health or get your procedure done through another provider.
The County is excited to announce the addition of the Carrum Oncology bundle which consists of Guidance and Treatment services. The Guidance bundle supports members with any cancer diagnosis. Members utilizing the Guidance bundle will be able to get a second opinion through Carrum and receive member support from the Carrum support team in partnership with their local oncologist. To access this, you can contact Carrum either by phone, website, or app.
The Treatment bundle is a treatment benefit available to those with non-metastatic, first-time breast cancer through City of Hope. Treatment for thyroid and colorectal cancer will follow at a later date. More information on this bundle will be coming soon!
For a full list of eligible procedures, visit Carrum Health’s website below.
Phone: (888) 855-7806
Carrum Health - Mandatory Second Opinion
The following criteria must be met to qualify for the Carrum Health program:
- You have primary medical coverage through the County medical insurance PPO, EPO and HDHP plans.
- You meet requirements of the hospital/surgical center physician(s) considering your case. Additional diagnostic or medical services may be required.
- Your local physician agrees to assume care for you upon return home.
- You have an adult caregiver physically able to assist you during your care and travel if needed.
Individuals enrolled in the high deductible plans must first meet their deductible, but copays and coinsurance will be waived. The deductible is waived for those enrolled in all other County medical plans.
- Scripps Health offers bariatric, cardiac, total joint replacement and spinal surgeries.
- Providence Saint John's Health Center offers total joint replacement surgeries.
- Hoag Orthopedic Institute offers numerous outpatient orthopedic procedures.
- Stanford ValleyCare offers total joint replacements.
Coverage includes the following:
- All eligible medical expenses associated with your evaluation or procedure at the facility.
- Travel expenses for you and one adult companion including transportation, lodging, and a daily allowance.
- Medically necessary services or equipment related to this program provided after discharge from the facility before returning home (excluding outpatient medication).
The following expenses are covered for you and one companion:
- Transportation – air, train, bus, rental car or mileage allowance (if driving your own car).
- Lodging – one hotel room to be shared by you and one adult companion.
- Meals – a daily allowance.
- Parking and baggage fees – as appropriate.
Per IRS rules, a portion of the covered travel expenses will be reported as taxable income to the employee. Due to IRS regulations, on HSA plans the deductible applies but coinsurance is waived.
Your personal Carrum Health Care Concierge will make all travel arrangements for you and one adult companion.