Does the University of Rochester Participate With WellCare Medicare Plans

What You Need to Know About University of Rochester and WellCare

The University of Rochester Medical Center does participate with WellCare Medicare plans, but the specific coverage depends on which WellCare plan you have and which part of the medical center you need to visit. WellCare offers several types of Medicare plans — Original Medicare Advantage plans, Prescription Drug Plans (Part D), and Dual Special Needs Plans for people with both Medicare and Medicaid. Not every WellCare plan covers every department or location at the University of Rochester system equally.

Before scheduling an appointment or procedure at University of Rochester, you need to know which WellCare plan you are enrolled in and whether that specific plan lists the provider or facility you want to use. This matters because using an out-of-network provider when you have a Medicare Advantage plan usually costs you more money out of pocket, and some services may not be covered at all.

Key Takeaways

University of Rochester Medical Center participates with WellCare Medicare plans, but participation varies by plan type and location within the system.
You must check your specific WellCare plan's provider directory before scheduling to confirm the doctor or facility is in-network for your plan.
WellCare's customer service phone number is on the back of your insurance card and can tell you in minutes whether a specific provider is covered under your plan.
If you use an out-of-network provider at University of Rochester, you may owe higher copays, coinsurance, or the full cost of the visit.

How to Check if Your WellCare Plan Covers University of Rochester

The fastest way to confirm coverage is to call the customer service number on the back of your WellCare insurance card. Have your plan name and member ID ready. Tell them you want to see a specific doctor or department at University of Rochester Medical Center, and they will tell you whether that provider is in-network for your plan.

You can also check online through WellCare's provider directory on their website. Log in with your member ID, search for "University of Rochester," and the directory will show you which doctors and facilities at that location are in-network. If you do not have online access or the website is unclear, calling is always the safer choice — a representative can answer follow-up questions about your specific plan's coverage.

What Happens if University of Rochester Is Out of Network for Your Plan

If the doctor or facility you need at University of Rochester is not in-network for your WellCare plan, you have several options. First, ask WellCare whether they can make an exception or authorize the visit as in-network — this sometimes happens for specialized services not available closer to you. Second, you can ask University of Rochester whether they have other doctors on staff who are in-network with your plan. Third, you can choose to go out of network and pay the higher cost yourself.

Out-of-network costs under a WellCare Medicare Advantage plan are usually higher than in-network costs. You may owe a larger copay, coinsurance (a percentage of the bill), or even the full cost of the visit. Some WellCare plans have an out-of-network deductible that is separate from the in-network deductible, meaning you pay twice. Ask WellCare for a cost estimate before you schedule if the provider is out of network.

University of Rochester Locations and WellCare Coverage

The University of Rochester Medical Center includes the main hospital, urgent care centers, specialty clinics, and affiliated practices across the Rochester area. Not all of these locations may be listed the same way in WellCare's directory. When you call or search online, use the full name of the specific location or doctor you plan to visit — searching for just "University of Rochester" may not show you every facility or department.

If you are having trouble finding a specific location in the directory, ask WellCare for the tax ID or National Provider Identifier (NPI) number of the facility. This is a unique number that identifies each provider in the system and makes the search more accurate. You can also call University of Rochester's main phone line and ask whether they are in-network with your specific WellCare plan.

What to Do Before Your Appointment

Once you have confirmed that your provider or facility is in-network, call ahead to schedule your appointment. Tell the scheduling staff that you have WellCare Medicare and ask whether they need any additional information from you. Some offices ask for a copy of your insurance card or your member ID before your visit.

Bring your WellCare insurance card and a photo ID to your appointment. If you have a referral requirement under your plan, make sure you have the referral from your primary care doctor before you go. Ask the front desk staff to confirm your copay or coinsurance amount before you see the doctor, so there are no surprises when you receive your bill.

Changes to WellCare Plans and Provider Networks

WellCare's network of in-network providers changes throughout the year. A doctor or facility that was in-network last year may not be in-network this year, or vice versa. This is especially true if you switch WellCare plans during the annual enrollment period (October 15 to December 7 each year).

If you see the same doctor regularly, check the provider directory again at the start of each calendar year or whenever you receive a new insurance card. If your regular doctor leaves the WellCare network, WellCare is usually required to give you notice and a grace period to find a new in-network provider. Contact WellCare when ready if you receive a notice that your doctor is no longer in-network.

Frequently Asked Questions

Can I go to University of Rochester without checking the network first?

You can, but you risk owing more money. If the provider is out of network, you will owe higher costs. It takes five minutes to call WellCare and confirm, which is much faster than dealing with a surprise bill later.

What if WellCare says University of Rochester is out of network but the hospital says they accept WellCare?

Call WellCare again and ask them to check their system while you are on the phone. Sometimes there is a delay in their directory, or the hospital may be in-network for some plans but not yours. If there is a disagreement, ask both WellCare and the hospital to put their answer in writing so you have proof of what was covered.

Do I need a referral to see a specialist at University of Rochester?

It depends on your WellCare plan. Some WellCare Medicare Advantage plans require a referral from your primary care doctor before you see a specialist; others do not. Check your plan documents or call WellCare to find out whether you need a referral for the specific specialist you want to see.

What if I need emergency care at University of Rochester?

Emergency care is covered by WellCare regardless of whether the hospital is in-network, as long as it is a true emergency. Go to the emergency room and bring your insurance card. Tell the staff you have WellCare Medicare. You may still owe a copay, but the visit will be covered.

Can I change my WellCare plan if University of Rochester is not in-network?

Yes, but only during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event like moving to a new state. If you need care before then, you can ask WellCare for an exception or look for an in-network provider in the meantime.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.