Avoid a Penalty: Surgery Decision Support

It’s Required

As a reminder, you must participate in Surgery Decision Support (SDS) if you or your covered dependent(s), age 18 or older have a physician-confirmed diagnosis and recommendation for one of the following procedures (emergencies excluded). If you do not complete the SDS process, you will pay a $1,000 penalty at the time your claim is processed.

  • Hip replacement
  • Knee replacement
  • Weight loss surgery
  • Low back surgery
  • Hysterectomy

Pearson has targeted these five procedures because they are associated with significant treatment variation and are usually planned in advance, allowing enough time to learn about other options. Patients are often presented with just one treatment plan, even though others may be available. For example, when patients considering back surgery were fully informed about their options, 35 percent chose an alternate treatment.

SDS provides confidential assistance and information about the risks, benefits and alternative treatment options associated with the five surgeries.

Here’s how it works

  • Enroll in the SDS program by calling ConsumerMedical at 1-888-361-3944 at least 30 calendar days before the date of your scheduled surgery.
  • Actively work with a Nurse Ally to get information about your diagnosis, treatment options, questions to ask your doctor and specific information based on your preferences. This includes an initial phone call and one or more follow-up calls with your Nurse Ally.
  • Complete a telephone survey at the end of the program.

Once you complete these steps, you will receive a certificate of completion. If you decide to have the surgery anytime in the following 12 months, you will not have to pay the additional $1,000.

To learn more, call 1-888-361-3944, review this brochure or visit myconsumermedical.com (enter Pearson in the company code field).

Please keep in mind that you will make the final decision about your care. The SDS program will not tell you what treatment to have or what doctor to use. Pearson just wants you to have the most information to make the best choice for you.