Are You Covered?

You may not be thinking about cancer now, but you need to be ready if you hear the words, "You have cancer."

Ensure that your health insurance plan allows for full access to Roswell Park services.

Open enrollment period is the time to take action if your plan does not provide adequate in-network coverage of Roswell Park services.

When is Open Enrollment?

Depending on your type of health insurance, there are rules about when you can enroll in another health insurance plan.

Medicare

Open enrollment period runs from October 15th through December 7th.
Is Roswell Park In Your Network?

Job-based Plans

Open enrollment periods are determined by your employer, but are typically in the fall.

Medicaid, the Essential Plan, and Child Health Plus

Enroll at any time.

NY State of Health Marketplace

Open enrollment period runs from November 1st through January 31st.

Medicare Health Plan and Network


Roswell Park In-Network Health Plans
Blue Cross Blue Shield (e.g. Senior Blue, Forever Blue, or PPO plan)
Independent Health (e.g. IHA Encompass 65)
Univera Health (e.g. Univera Senior Choice)
MVP (e.g. MVP Gold)
Dual Policies - Medicare Advantage with Medicaid Secondary
Traditional Medicaid
Traditional Medicare with Supplemental or Secondary Insurance (e.g. United Healthcare, AARP, Empire, Medicaid)
NOTE: Services are subject to each plan's pre-authorization requirements.
Roswell Park Out-of-Network Health Plans
Aetna
Emblem
Fidelis
Humana
Medicare Dual Advantage (e.g. United Healthcare, Wellcare, Fidelis)
United Healthcare (UHC)
Wellcare
NOTE: If you are insured with one of the above out-of-network health plans you may not be able to receive care at Roswell. You may be subject to higher member out-of-pocket costs because we are out-of-network with these plans.

All Health Plans and Networks


Insurance Company Insurance Product Roswell Park Hospital Participation Status Roswell Park Physician Participation Status
Aetna* Commercial/Self Funded Yes if accessed through Magnacare** Yes if accessed through Magnacare**
Medicare No** No**
Medicaid No No
Aetna Dental Dental Network n/a Yes
Allegany/Cattaraugus County Cancer Services Program Other Yes Yes
Azeros Health Plan (Nova Dentalcare) Dental Network n/a Yes
BDCT (Blue Distinction Centers) - Transplant Network Other Yes Yes
Blue Cross Blue Shield of Western New York (HealthNow) Commercial/Self Funded Yes Yes
Medicare Yes Yes
Exchange Yes Yes
Child Health Plus Yes Yes
Medicaid Yes Yes
Chautauqua County Cancer Services Program Other Yes  
Cigna* Commercial/Self Funded Yes if accessed through MVP** Yes if accessed through MVP**
Medicare No No
Cigna LifeSource - Transplant Network Other Yes Yes
Delta Dental Dental Network n/a Yes
Dentaquest Dental Network n/a Yes
Emblem Health/GHI Commercial/Self Funded Yes Yes
Medicare Yes Yes
EPP No No
Medicaid Yes Yes
EmpirePlan (UHC) Commercial/Self Funded Yes *Physicians covered by United, Hospital services covered by BCBS
Erie County Cancer Services Program Other Yes Yes
Fidelis Medicare No** No**
Exchange No** No**
EPP Yes Yes
HARP No No
Medicaid Yes Yes
Fully Integrated Dual Eligible (FIDA) No No
Child Health Plus Yes Yes
First Health/Coventry Other Yes Yes
HealthPlex Dental Network Yes Yes
Humana - ChoiceCare Commercial/Self Funded Yes Yes
Medicare No** No**
Independent Health Commercial/Self Funded Yes Yes
Health Benefit Exchange Yes Yes
Medicare Yes Yes
Medicaid Yes Yes
Essential Plans Yes Yes
Child Health Plus Yes Yes
Exchange Yes Yes
Interlink - Transplant Network Other Yes Yes
LifeTrac - Transplant Network Other Yes Yes
Lifetime Benefit Solutions (EBS-RMSCO) Commercial/Self Funded Yes Yes
Magnacare Commercial/Self Funded Yes Yes
Medicare No No
Medicaid No No
Martin's Point Healthcare (US Family Health Plan) Other Yes Yes
MedCal Other Yes Yes
Medicaid (New York) Medicaid Yes Yes
Medicare Medicare Yes Yes
Multi Plan (PHCS - Private HealthCare Systems Inc) Other Yes Yes
MVP (Preferred Care) Commercial/Self Funded Yes Yes
Medicare Yes Yes
Exchange Yes No
EPP Yes No
HARP Yes Yes
Medicaid No No
Niagara County Cancer Services Program Other Yes Yes
Optum Health (URN CRS) - Transplant Network Other Yes Yes
Three Rivers Provider Network Other Yes Yes
UHC Dental Dental Network n/a Yes
United (UHC)* Commercial/Self Funded Yes if accessed through Multiplan or CRS** Yes
Medicare Yes if accessed through Multiplan or CRS** No
Exchange No No
Medicaid Yes if accessed through Multiplan or CRS** No
Univera HealthCare Commercial/Self Funded Yes Yes
Medicare Yes Yes
Exchange Yes Yes
EPP Yes Yes
YourCare EPP Yes Yes
Medicaid Yes Yes
Child Health Plus Yes Yes

*If you are accessing Roswell Park Cancer Institute with one of these health plans, please be advised that you may be subject to higher out of pocket costs.

** Although Roswell Park Cancer Institute is not directly participating with the health plan, please call us at 1-877-ASK-RPCI to determine if your plan allows for out of network benefits.

 

Have Questions?

Roswell Park's financial counselors are ready to assist you with any of your open enrollment, health insurance and billing questions.

Ask a Question

Or call 1-877-ASK-RPCI (1-877-275-7724)

Hear From Our Experts

Our experts are here to help you make sense of your health insurance, network access or your medical bills. 

If tragedy strikes, you want to be prepared. Kim Sweeney, Director of Patient Access, explains why it’s important to plan ahead.
Choosing the best insurance plan for you and your family can get complicated. Stephanie Evans, Financial Counseling Manager, is here to help you make sense of it all.
Do you have in-network coverage? Terrie Kothe, Vice President of Managed Care, works with insurance companies to negotiate in-network coverage of Roswell Park services.

 

FAQ

Here are answers to some of the most common questions about open enrollment.


Open enrollment is the period of time each year when you can enroll in a health insurance plan. Typically you cannot enroll in or change plans outside the open enrollment period unless you have a qualifying life event (e.g. loss of insurance, permanent move to a new area, loss of job, divorce/marriage, age off parent’s plan).


  • Medicare’s open enrollment period runs from October 15th through December 7th.
  • NY State of Health Marketplace’s open enrollment period runs from November 1st through January 31st.
  • Open enrollment period for job-based plans is determined by your employer, but is typically in the fall.
  • Medicaid, the Essential Plan, and Child Health Plus allow you to enroll at any time.


Each insurance company offers many different types of plans, and Roswell Park may not accept all of these plans.

As an example, Roswell Park may participate with an insurance company's Medicaid Managed Care and Essential Plans, but does not participate with that company's Medicare Advantage or Metal-Level Products purchased through the Marketplace.

View Health Plans and Networks

 


Yes, Roswell Park accepts both traditional Medicare and New York State Medicaid.

  • If you are enrolling in a Medicare Managed Care Plan, please consider enrolling in a plan that is in-network with Roswell Park (BlueCross BlueShield of WNY, Independent Health, MVP, and Univera Healthcare). Otherwise, if you choose a plan that is out-of-network, your plan may not cover your services at Roswell Park and/or you may have higher out-of-pocket costs.
  • If you are enrolling in a Medicaid Managed Care Plan, you should select a plan that is in-network with Roswell Park (BlueCross BlueShield of WNY, Fidelis, Independent Health, and Yourcare). Otherwise, if you choose a plan that is out-of-network, all services will require prior authorization and/or you may not be able to receive services at Roswell Park.


Please contact your insurance company to find out if your plan is participating with Roswell Park and its providers. You can also call us at 1-877-ASK-RPCI or ask us a question.


When a provider is in-network it is contracted with the insurance plan to provide services to its members. An out-of-network provider is not contracted with the insurance plan. If you receive services from a provider that is in-network, your out-of-pocket costs will typically be less than if you receive services from an out-of-network provider. Services provided by out-of-network providers may not be covered under your plan. 


If you have out-of-network benefits, you may be able to still receive services at Roswell Park. However, an out-of-network authorization may be required – this means we would need a prior approval by your insurance plan for you to have services at Roswell Park. Another important factor to consider when deciding to go to an out-of-network provider is the financial responsibility. Typically an insurance plan will pay less when you receive services out-of-network and will hold you responsible for a larger portion of the bill. For example, you may have 20 percent coinsurance for in-network services, but 40 percent coinsurance when you go out-of-network. In addition, you may be responsible for paying the difference between Roswell Park's charges and your insurance plan’s usual and customary rates.


There are many factors to consider and compare when picking an insurance plan, but two key components are coverage and cost. First, you want to make sure the providers (your primary care doctor, specialists, hospitals, etc.) that you use are in-network and participating with the plan you choose. Second, you should consider the total health care costs (monthly premium, deductible, copays and coinsurance, and out-of-pocket maximum). Generally, plans with higher premiums have better coverage and lower out-of-pocket expenses.


Is Roswell Park Cancer Institute and its providers in-network with my plan? (You may need to provide our Tax ID number 161552370 and our NPI numbers: Roswell Park (Hospital) 1548315401 and Roswell Park (Physicians - RPCI CPP) 1720036593)

If yes:

  • What are my co-pays for specialist office visits, ambulatory surgery, chemotherapy, radiation, radiology, and inpatient admissions?
  • What is my maximum out-of-pocket cost (MOOP)?

If no:

  • Do I have out-of-network benefits?
  • Does my plan require out-of-network authorizations?
  • What are my out-of-network benefits (deductible, coinsurance, out-of-pocket maximum)?
  • Does my insurance plan access any special networks (such as Cancer Resource Services, MultiPlan, or MagnaCare) for which Roswell Park is an in-network provider?
  • Will I be balance billed for the difference between the usual and customary rates and Roswell Park’s charges?

 

From the Cancer Talk Blog

Thursday, March 31, 2016 - 6:07pm

To kick off National Young Adult Cancer Awareness Week (NYACAW) I’m headed to Roswell Park’s Annual Young Adult Wellness Retreat this Saturday to speak with patients and survivors about important topics that impact their lives.

Monday, October 19, 2015 - 12:42pm

During the Medicare Open Enrollment period many patients may have questions about the various Medicare options. This open enrollment period is the one time each year that ALL people with Medicare can make changes to their health plan, such as switching from original Medicare to a Medicare Advantage Plan or choosing a different Medicare Advantage Plan.

Thursday, October 1, 2015 - 12:55pm

Buying health insurance on the Health Benefit Exchange is a daunting task that can be fraught with pitfalls, especially if you or a family member has cancer. There are plenty of helpful resources however, and if you tread carefully and thoughtfully, you can make choices that provide the best coverage for your medical and prescription drug needs.