We know how difficult a cancer diagnosis can be, and we are committed to helping you get the care you need. Dana-Farber and our affiliated physicians are contracted with an extensive list of local and national health insurances and participate in their
network of providers. Even if your plan is listed below, it is important to learn how your benefits will apply at Dana-Farber. Many programs require referrals and authorizations for specific services and some may require patients to pay for a portion
of the care. We encourage you to contact your health plan to better understand these details.
Accepted insurance plans
This list is not specific to individual product offerings and is subject to change.
Health Plan Companies
Blue Cross Blue Shield of MA*
Coventry Health Care
Fallon Community Health Plan
Harvard Pilgrim Health Care*
Maine Community Health Options
Healthcare Systems (PHCS)
Neighborhood Health Plan
OptumHealth Care Solutions (Cancer Resource Services)
Tufts Health Plan*
Tufts Health Together
UniCare Life & Health
UnitedHealthcare Insurance (PPO and POS only)
Stem Cell Transplant Networks
Aetna Health Institute of Excellence
Coventry Transplant Network
Health Value Management/Humana
INTERLINK Health Services
OptumHealth Care Solutions
Protocol Tertiary Networks
One Care (MassHealth and Medicare)
Commonwealth Care Alliance (CCA)
Tufts Health Unify
Health Safety Net
International Health Plans
CMN Global Inc.
For adult international patients, Dana-Farber coordinates services with Brigham and Women’s Hospital through their International Program.
For pediatric international patients, Dana-Farber coordinates services with Boston Children's Hospital through their International Health Services. Both of these offices ensure
that patients are clinically appropriate for services, assist in the coordination of travel and logistical details, and prepare financial and billing arrangements, including detailed estimates and consolidation of invoices from various care providers.
To speak to a Dana-Farber financial counselor regarding these services, please call 617-632-3455 (option 1).
*These payers have a small number of products that limit access to certain facilities; please check with your insurance company to verify coverage.
**If you have a Medicaid or Medicare Managed Care product (HMO), contact your health plan.
If your plan is not listed or if you are unsure whether your health insurance is going to be accepted, contact your insurance company directly.
Other partnering providers
A portion of your care may be provided by one of our clinical partners, which is specific to your Dana-Farber location. In Boston, Dana-Farber is very closely aligned with Brigham and Women's Hospital and Boston Children's Hospital. We also provide adult services at several satellite locations. Each provider will work with
you in understanding your health insurance coverage for their services.
Understanding your insurance policy
Each insurance policy is different; contact your insurance company for the specifics of your policy (the phone number is usually on your insurance card). They should be able to tell you about in-network and out-of-network coverage for care at Dana-Farber,
as well as what your financial responsibility will be if you become a patient here.
Some insurance companies require referrals and other approvals from your PCP or health plan before you can receive treatments.
The level of coverage for exams and procedures depends on your specific health plan, so it is important to read and understand your policy.
Since patients are fully responsible for all bills related to treatment, it is important for you to know the details of your insurance coverage and out-of-pocket expenses.
Questions to ask your insurance company
Use these questions as a guide when you talk to your insurance company about your coverage options. Be sure to note the name of the person you spoke with and the date; this will be important to refer back to in case you have any questions in the future.
- What type of insurance plan (HMO, POS, PPO) do I have? What does this mean in terms of where I receive my care and if I will have out-of-pocket expenses?
- Is Dana-Farber Cancer Institute in my network? If so, does my insurance plan cover physician costs as well as inpatient and outpatient hospital services? What, if any, are my out-of-pocket expenses, including co-payments?
- If Dana-Farber is not in my network, and I go out of network, what percentage of the bill can I expect to be responsible for?
- Does my policy have an out-of-pocket maximum? If so, how will this work?
- Before I see a doctor at Dana-Farber, do I need a referral from my primary care physician and/or will I need authorization from my insurance carrier?
- Will I be covered for any testing, pathology or radiology charges that may be incurred as part of my initial consultation with a Dana-Farber doctor?
- Does my insurance plan offer any additional coverage — for example, traveling and lodging benefits for transplant — through special networks or programs?
Frequently Asked Questions for Patients and Their Health Care Providers
What is prior authorization?
A prior authorization is a decision made by your health insurance provider to approve services out of network based on medical necessity. A prior authorization may also be called:
- Out-of-Network Referral
- Out-of-Network Authorization
- GAP Exception
How do I request a prior authorization for out-of-network coverage?
Your Primary Care Physician (PCP) or In-Plan Referring Provider will need to work with your health insurance provider to request that Dana-Farber’s medical services be covered at the in-network benefit level.
The Standardized Prior Authorization Request Form already includes the following information, which your health insurance provider will need when reviewing your request:
- Dana-Farber NPI (National Provider Identifier): 1851333686
- Dana-Farber Tax ID Number: 042263040
- CPT/Procedure Codes:
- New patient evaluation and management codes: 99201-99205
- Established patient evaluation and management codes: 99211-99215
- Pathology review codes: 88321, 88323, 88342, 88346, 88360
If my health insurance provider approves my out-of-network request, what happens next?
- Your insurance provider will provide you with an authorization number that you should write down and keep for reference.
- Call your New Patient Coordinator at Dana-Farber to provide the authorization number. Your New Patient Coordinator will record the authorization number and schedule an appointment for you with a physician and a Dana-Farber financial counselor.
- A Dana-Farber financial counselor will call your insurance provider to validate your authorization number. Then the counselor will call you to confirm that the authorization is valid and note that any future appointments may be subject to further financial clearance.
What if my health insurance provider denies an out-of-network request?
- Your insurance provider should be able to provide a reference number associated with the denial. Write this number down and keep it for reference.
- Call your New Patient Coordinator at Dana-Farber to provide the denial reference number. Your New Patient Coordinator will record the number and schedule a phone call for you to speak with a Dana-Farber financial counselor.
- A Dana-Farber financial counselor will work with you to go over your options, including the potential cost of the visit and waiver requirements.
Mass Health Members:
If your insurance is out-of-network with Dana-Farber but is a product of MassHealth, you may be able to switch to a plan in-network with Dana-Farber.
This switch can be completed by calling MassHealth at 800-841-2900 or by visiting: https://masshealth.ehs.state.ma.us/StateForms/.
This switch may require a PCP referral, which is the directing of a patient to a medical specialist by a primary care physician.
MassHealth plans that are in-network with Dana-Farber include:
- Tufts Health Public Plan MCO
- Tufts Health Public Plan Atrius ACO, PCP referral is required
- Tufts Health Public Plan BIDCO ACO, PCP referral is required
- Tufts Health Public Plan CHA ACO, PCP referral is required
- Tufts Health Public Plan Boston Children's ACO, PCP referral is required
- MassHealth PCC, PCP referral is required
- MassHealth PCC with Comm Care Coop (C3), PCP referral is required
- MassHealth PCC with Partners ACO, PCP referral is required
- MassHealth PCC with Steward ACO, PCP referral is required
- Neighborhood Health Plan My Family Cares, PCP referral is required
How we help
Our Financial Counselors are ready to guide you every step of the way as you consider Dana-Farber. Whether you have questions about coverage, payment plans, price estimates, or Medicaid applications, a financial counselor can help you sort through the details and steps needed to make your financial arrangements go smoothly. Please call 617-632-3455 (option 1) to speak to a financial counselor.
In addition, our Customer Service representatives are available at 617-632-3795 or 866-408-4669 to answer any questions you have about your bills and/or statements.