UPMC Health Plan Insurance – New York Urology Specialists

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 UPMC Health Plan 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.


If you have any questions about your insurance benefits, to schedule a consultation or if you need a second opinion, please contact us.  

We would be happy to check your health insurance benefits from UPMC Health Plan and to explain to you the costs (copays, coinsurance, deductible) that apply to you.


PPO Plans:

If your health insurance plan from UPMC Health Plan 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 UPMC Health Plan or non-covered by UPMC Health Plan.  This determination is a business decision based on terms of your agreement with UPMC Health Plan.   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.

HMO Plans:

Most HMO plans do not have out-of-network benefits and your care at New York Urology Specialists will not be covered by you UPMC Health Plan 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 UPMC Health Plan 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.

Why are you not in-network with UPMC Health Plan?

We understand that many patients with UPMC Health Plan are looking for high quality urology care in NYC but have difficulty finding urologists who accept their plan in-network in New York City, Brooklyn, Queens, Long Island, Westchester and surrounding areas.

If your plan has no out-of-network benefits or you cannot afford the higher fees for out-of-network care imposed by your insurance plan, please contact UPMC Health Plan and request that they authorize out-of-network care at New York Urology Specialists.

Just as there are inexpensive drive-by fast food restaurants and more expensive sit-down restaurants with chef-prepared means, medical care is offered by a variety of providers.

UPMC Health Plan is an out-of-state insurance and does not accept providers in NYS.

We understand that health care is expensive.  While the quality of care is a paramount consideration, the costs of care are important to consider as healthcare costs can be considerable for patients with significant medical and urological problems.  

We encourage your to compare our prices to comparable in-network providers with your plan.  You will often find that our fees are comparable and are often lower than the fees that your insurance company has negotiated with other providers.  New York Urology Specialists is an independent physician-owned and physician managed practice.  As such we are free to refer you to highest quality and fairly priced independent providers of ancillary services.  Most urology practices in New York area are owned and operated by hospitals; these mandate that the employed physicians refer you to high-cost hospital based testing, including hospital laboratories, hospital radiology centers and hospital-based surgical centers. You may also be subject to hidden ‘facility’ fees for seeing hospital-employed physicians as well as other hospital-based providers for office visits.

There are many hidden fees in healthcare. You should be aware that physician fees will typically comprise a small fraction of your total costs of care. 

Many hospital-based tests, procedures and surgeries can be provided at a fraction of the cost by independent laboratories, testing centers and surgical centers with equal or better quality and lower cost.

We encourage our patients to compare prices. We are confident that when the overall costs of care (physician fees, testing and laboratory as well as surgical facility fees) are compared, many patients will discover that the care provided at New York Urology Specialists is not only of higher quality but at lower cost than what comparable care costs at some in-network facilities.