The following is a list of plans accepted for General Primary and Preventative Care at this time. Please check back with our office as this list may not be current Acupuncture services are only covered under United Healthcare and Cigna. Dr. Pedre is currently accepting new patients on all plans, except Medicare, but please check with our office as this may also change in the future.
- Aetna HMO
- Cigna HMO
- Oxford (Freedom, Medicare)
- United Healthcare*
- UHC-top tier* (Mount Sinai Hospital employees only)
Out of Network
If you have Blue Cross/Blue Shield or any other insurance not listed above, our services are out-of-network for you.
This does not mean that you cannot receive care from our office. What this means is that you will have to pay out-of-pocket for any services provided. We will provide you with the proper forms to file with your insurance company so that you may seek reimbursement for your medical expenses. Usually expenses are reimbursed at 80% of qualified medical expenses beyond your deductible.
What is an out-of-network deductible?
This is the amount you need to pay out-of-pocket for any services not covered by your insurance plan. The deductible does not carry over past January 1st ; in other words, your deductible resets at the beginning of the calendar year whether or not it has been met. Your deductible is the amount you have to first pay out-of-pocket, after which your insurance will cover and reimburse you for a prearranged percent of eligible medical expenses. For example, your deductible may be $200, $500, $1000 or $2000. The amount they may reimburse you for after your deductible has been met is usually in the range of 75% – 80% of qualified medical expenses (again incurred after you have met your deductible). This means you are responsible for the other 20-25%, unless you have secondary insurance. There may also be different deductibles for outpatient versus inpatient (or hospital) services as well as yearly in-network deductibles that vary from plan to plan. There is no way to know this without calling your insurance plan and inquiring. Complicated? Not really, but it takes a little bit of thinking to understand.
If you need any help understanding these concepts, or would like to make an appointment, please do not hesitate to contact our office at (212) 860-8300.
Functional Medicine Concierge Program
Truth No. 1: Your health is an investment.
Truth No. 2: Invest in your health.
Truth No. 3: Postponing your health may make it even more expensive.
Functional Medicine is root cause-based medicine. This type of medicine requires extended visits (much longer than reimbursed by insurance) to be able to dig deep into the underlying cause(s) of your chronic health issue(s). Our goal is to work closely with you, guiding you towards the medical and lifestyle changes that can get you healthy, minimize the effects of chronic disease, reduce stress, and keep you on the path to long-term wellness.
This is why Dr. Pedre offers this program to a select group of patients. Enrollment in this program is limited. If you want to work with Dr. Pedre in this intimate fashion, we encourage you to strongly consider enrolling in the Functional Medicine Concierge Program.
To be considered for enrollment click here.
Please call us at (212) 860-8300 to find out our rates and learn how we can help out.