Understanding Health Insurance

Health insurance plans are not equal. Your financial obligation resulting from your cancer treatment will depend on many factors, including whether your insurance plan covers cancer care at Roswell Park, whether Roswell Park is an in-network provider in your plan, as well as your plan’s deductibles and copays. The most important thing is that you have access to the quality care you deserve.

Does my insurance cover care at Roswell Park?

You will need to know the name of your health insurance company as well as the name of your specific plan. Each insurance company offers many different plans, and not all of them may include care and services at Roswell Park. For example, Roswell Park may participate with a company’s Medicaid Managed Care and Essential Plans, but not with that same company’s Medicare Advantage plan or Metal-level plans purchased through the healthcare Marketplace.

How do I find a better plan?

Two major factors to consider when choosing a health insurance plan are coverage and cost. As you compare plans offered by different companies, you will see that not all have in-network access to Roswell Park Comprehensive Cancer Center and its providers. You need to choose a plan that covers your cancer treatment, the hospital where you are treated, and the services of the doctors treating you.

• For plans with in-network access, review your benefit options carefully. Different plans come with different out-of-pocket costs for specialist office visits, outpatient surgery, chemotherapy, radiation therapy, medical imaging and inpatient care.
• For out-of-network plans, ask if they provide out-of-network benefits and if authorizations are required for out-of-network care at Roswell Park. How much will you pay for the deductible and coinsurance, and what is the out-of-pocket maximum?
• For more information, contact the insurance provider you are considering, and ask if Roswell Park and its providers are part of its network. You may need to provide Roswell’s tax ID number (161552370) and NPI numbers (Hospital 1548315401 and Physicians 1720036593).
• If you have any questions, call a Roswell Park financial counselor at 716-845-4782.

What steps can I take if my plan denies coverage at Roswell Park?

If your health insurance plan informs you that you are not allowed to go to Roswell Park for any reason, you may want to consider taking the following steps to appeal their decision:

Step One: Work with your health insurance plan

• Health insurance plans have a member handbook which explains policies and procedures, and describes formal grievance or appeal processes. If you do not have a copy of this handbook, call your insurance carrier to request one.
• Remember to keep detailed written records of phone conversations, contacts and phone numbers, and copies of all papers and dated letters. You may be asked to provide this information during the grievance process.

Step Two: Dealing with unresolved disputes

• If, after exhausting all avenues with your health care plan, you are still dissatisfied with the decision made regarding your grievance, you have the right to file a complaint with the New York State Insurance Department Consumer Services Bureau (800-342-3736) or the New York State Department of Health Managed Care Hotline (800-206-8125)
• The New York State Department of Health has regulatory oversight of the grievance and appeal processes under the New York State Managed Care Law.

Medicare and Medicaid

For more information read our blog, "Understanding health insurance: Top 5 Terms to Know."

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

However, Medicare Managed and Medicaid Managed plans are different and the most important thing to learn is whether Roswell Park is listed as an in-network provider. If Roswell Park is not in-network, all services will require prior authorization, the insurance may not cover your services, you may have higher out-of-pocket costs, and/or you may be able to receive services at Roswell Park.

Patients with Medicare coverage may be eligible for co-pay assistance for drug treatments, including chemotherapy, through foundations such as the Patient Access Network Foundation. Patients with commercial insurance coverage may be eligible for copay assistance for drugs through a drug company’s assistance program. These programs do have eligibility requirements (diagnosis, income limits).

In-network coverage

Your insurance company will tell you if you have in-network coverage of services at Roswell Park. You want to make sure your primary care doctor, specialists and hospitals also are contracted with your insurance company so the treatments and services they provide you are covered. Out-of-pocket costs, like co-pays, typically are lower with an in-network provider.

You may still be able to receive services at Roswell Park with an out-of-network insurance plan; however, pre-approval from your insurance carrier may be required before you are treated here. Also, insurance plans often pay less for out-of-network services, leaving you responsible for a larger portion of your bill. Read about New York State's Rights and Protections Against Surprise Medical Bills.

If you have an out-of-network plan, ask your insurance company if they provide out-of-network benefits and if authorizations are required for out-of-network care at Roswell Park. Other questions you should ask include:

• How much will I pay for the deductible and coinsurance?
• What is the out-of-pocket maximum?
• Will there be balance billing?