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
| 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 Healthcare (e.g. Univera Senior Choice) |
| MVP (e.g. MVP Gold) |
| Traditional Medicare |
| Traditional Medicare with a Supplemental or Secondary Insurance Plan (e.g. United Healthcare AARP Supplement, Empire, etc. |
| Traditional Medicare with Medicaid Secondary |
| NOTE: Services are subject to each plan's pre-authorization requirements. |
| Out-of-Network Health Plans |
|---|
| Aetna |
| Emblem |
| Fidelis |
| Humana |
| Wellcare |
| United Healthcare (UHC) |
| Medicare Dual Advantage (e.g. United Healthcare,Wellcare, Fidelis) |
| 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 | Hospital Participation Status | 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.
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.
FAQ
Here are answers to some of the most common questions about open enrollment.
What type of insurance does Roswell Park Cancer Institute accept?
Each insurance company offers many different type 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.
What is 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).
When is open enrollment?
- 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.
- Job-based plans’ open enrollment period is determined by your employer, but are typically in the fall.
- Medicaid, the Essential Plan, and Child Health Plus allow you to enroll at any time.
Does Roswell accept Medicare and Medicaid?
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 Blue Shield 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.
How do I know if my insurance covers Roswell Park as a provider?
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 email us at askrpci@roswellpark.org with questions.
What is the difference between in-network and out-of-network?
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.
Will I be able to receive services at Roswell if my insurance plan is out-of-network?
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% coinsurance for in-network services, but 40% 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.
What do I consider when picking an insurance plan?
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.
What questions should I ask my insurance plan about my coverage?
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?
