Our policy is to make available excellent urology care to all patients without regard to their insurance policy. For patients with health insurance policies that cover our fees, your costs will depend on your copay, deductible and co-insurance policy of your insurance plan. For patients with insurance policies that do not cover the fees for care provided by New York Urology Specialists, discounted self-pay rates are available for patient who prepay for their care in full at the time of visit.
New York Urology Specialists accepts patients with Harvard Pilgrim commercial health insurance plans.
New York Urology Specialists is not an in-network provider; this means that we do not have a contractual agreement; as a result we submit all claims as an out-of-network provider. Typically, there may be higher deductible / copay / coinsurance when you see an out-of-network provider.
Laboratory tests (blood tests, urine tests) can be performed at one of the laboratories that are in-network with your insurance. We typically use Labcorp, Bioreference and Quest Labs.
Radiology studies (CT scans, X-rays, ultrasounds) can also be done at one of the in-network facilities with your insurance plan of your choice.
We would be happy to check your health insurance benefits from Harvard Pilgrim Health Plans and to explain to you the costs (copays, coinsurance, deductible) that apply to you.
If your health insurance plan from Harvard Pilgrim has out-of-network benefits, all or part of your costs of care at New York Urology Specialists for medically-necessary care will be covered subject to terms and conditions of your health insurance policy (including copays/deductibles/coinsurance).
Some tests and procedures done at New York Urology Specialists may be considered not medically necessary by Harvard Pilgrim or non-covered by Harvard Pilgrim. This determination is a business decision based on terms of your agreement with Harvard Pilgrim. When you are offered or prescribed a course of treatment at New York Urology Specialists, our advice is based on best-available science and extensive experience treating patients with a given condition.
Most HMO plans do not have out-of-network benefits and your care at New York Urology Specialists will not be covered by your Harvard Pilgrim HMO plan.
If you have an emergency and cannot find an in-network urologist who can see you in an urgent manner, you may be able to appeal to Harvard Pilgrim to have your full or part of your bill covered.
At New York Urology Specialists, we require that you prepay your care. We can submit insurance forms (CMS 1500 form) with billing codes to your insurance plan on your behalf; if you prefer you can submit the forms on your own.
Obama Exchange Plans:
New York Urology Specialists is not in-network and does not accept Exchange plans as a payment method for our services. If you have an Obama Exchange plan, you can see our physicians but you would have to pay out-of-pocket. Oxford has offered rates that are too low for us to see patients with Obama Exchange plans.
Why are you not in-network with Harvard Pilgrim?
We understand that many patients with Harvard Pilgrim are looking for high quality urology care but have difficulty finding urologists who accept their plan in-network in New York City, Brooklyn, Queens, Long Island, Westchester and surrounding areas.
Because HealthNet is not a state insurer in NYS, we cannot join it as an in-network provider.