QualityPath Benefit Details Procedure: CABG (Coronary Arterial Bypass Graft)

Providers:

View list of providers performing CABG surgeries.

Notification requirements:

  • Call The Alliance Patient Experience Manager at 800.223.4139 prior to scheduling services.

Services covered at QualityPath level of benefits:

  • The initial consultation with the QualityPath surgeon
  • Pre-operative testing (lab, x-ray, and other tests as medically necessary)
  • Services provided on an inpatient basis, including the hospital facility fees, the surgeon’s fee, and any anesthesia, pathology or radiology charges associated with the procedure
  • The services of other medical professionals while the member is inpatient, including hospitalists and other specialists
  • Post-operative care for 90 days after the surgery. (See warranty for information regarding complications.)
  • Cardiac rehabilitation services performed by a QualityPath provider, in a QualityPath facility

Warranty:

Services under the warranty are covered under the QualityPath level of benefits. The warranty period begins the day of admission and covers the following care related to the QualityPath service:

  • Hospital readmission and reoperation – 30 day warranty period
  • Other treatment of complications – 90 day warranty period

Patient requirements to maintain the warranty include:

  • Receiving all follow-up care from the QualityPath provider, excluding necessary emergency care.
  • Complying with all post-discharge instructions, including outpatient cardiac rehabilitation.

Exclusions:

The following services are not eligible for the QualityPath level of benefits. Check with your benefits administrator for coverage levels under the standard health plan benefits.

  • All services provided by a non-QualityPath provider
  • Post-discharge care that is unrelated to the procedure
  • Unrelated readmissions during warranty period
  • Coverage for the same procedure during the warranty period, when not due to complications related to the initial procedure
  • Care related to the procedure rendered outside the 90-day warranty period
  • Services provided by a QualityPath provider performed prior to member’s enrollment in the program
  • Rehabilitation services outside the physician care plan
  • Services provided inpatient unrelated to the QualityPath procedure

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