Our Position on CDPHP

FAQs

What is the status of the payer contracts between the Albany Med Health System and CDPHP?
The Albany Med Health System has been negotiating since April with CDPHP to resolve the insurance company’s unfulfilled obligations to our hospitals. In October, we projected $50 million in payments CDPHP is withholding for care provided to its members in 2024 and anticipate additional significant shortcomings in 2025. We have not reached an acceptable agreement and a lawsuit against CDPHP for what is already owed is in process. While we remain hopeful an agreement will be reached, with few exceptions, the Albany Med Health System may be forced to remove CDPHP as an accepted insurance plan.

Are Albany Med Health System hospitals still accepting CDPHP?
Yes. At this time, the Albany Med Health System has not yet decided to drop CDPHP as an accepted insurance plan but will not negotiate a contract until the insurance company fulfills its outstanding obligations. The Albany Med Health System and CDPHP have agreed not to make any changes or decisions before Feb. 28, 2025.

How much money does CDPHP owe Albany Med?
We project CDPHP will have withheld $50 million in payments from Albany Medical Center for care provided to its members in 2024. Withheld claim payments to Albany Med from CDPHP have averaged $2 million per week. Additional shortcomings in 2025 could affect Columbia Memorial, Glens Falls, and Saratoga hospitals as well.

If it becomes necessary, what does the Albany Med Health System’s out-of-network status mean to our patients with CDPHP coverage?
Because CDPHP insurance coverage in this market includes a wide range of benefits and plan designs, each member will need to follow up with CDPHP Member Services to best understand their coverage. Depending on their specific type of benefit/coverage/plan, the CDPHP member may incur any of the following should they choose to receive services at an Albany Med Health System facility on an out-of-network basis:

• Higher out-of-pocket expenses than they were previously accustomed to
• Restricted access to some services that were previously available
• Access may be denied by CDPHP to services that were previously available due to the Albany Med Health System's out-of-network status. To ensure compliance, we must follow all appropriate steps currently in place to comply with the No Surprise Bill Act and Out-of-Network Consumer Protection Laws.

How might this impact the care provided at Albany Med?
CDPHP’s withholding of contractually required payments poses a monumental threat to local health care and Albany Med’s ability to sustain its scope and scale of services. With $50 million in funds potentially vanished this year and tens of millions in the future, we may have no choice but to reduce the number of services only we offer, forcing patients to seek care outside of this region.

Are other insurers also withholding payment to Albany Med?
No other insurers are withholding payment to Albany Med.

If possible, should I be considering another insurer?
There are many health insurance options available in our market. This page has a list of Accepted Insurance in the Albany Med Health System.

If CDPHP is my health care insurer is there anything I can do now?
You can certainly call CDPHP member services to tell them how important the health care services that are available in the Albany Med Health System are to you and your family. Many of those services are only available at Albany Medical Center because it is our region's only academic medical center.

What action has Albany Med taken to remedy the situation?
Albany Med has filed a prompt pay complaint with the state Department of Financial Services given the magnitude of claims impacted and the ongoing nature of violations. In addition, we filed a lawsuit on October 7 in State Supreme Court against the insurance company for failure to meet terms set forth in CDPHP’s current contract with Albany Med.

Is Albany Med "bullying" CDPHP by taking this public?
No, absolutely not. We are obligated to inform our patients and our staff members about the current situation as it has enormous potential to impact the care we can provide depending on a patient's insurance. We want the public to be well informed that we have filed a lawsuit against CDPHP and why.

I am an Albany Med Health System employee with a CDPHP employee health plan. Is CDPHP still going to be our employee health plan?
Right now, members of the Albany Med workforce who use CDPHP are still covered as usual. It's important to understand that the employee medical plans for Albany Medical Center, Glens Falls Hospital, and Saratoga Hospital are self-insured. CDPHP is the administrator of the plans and processes our claims, which is why the CDPHP logo is on your insurance card, however Albany Med pays the claims. All access will continue for Albany Med Health System and all other providers. While we are hopeful CDPHP will rectify its issue, we are prepared to shift the employee health plan to another insurer. Again, no final decision has yet been made, but participants in our employee health plans will remain fully covered. The Albany Med Health System and CDPHP have agreed not to make any changes or decisions before Feb. 28, 2025.

How do the Albany Med Health System employee medical plans administered or insured by CDPHP work?
Employees who participate in our employee health plans will continue to have access to services under the Albany Med Health System.

• The employee medical plans for Albany Medical Center, Glens Falls Hospital, and Saratoga Hospital are self-insured. All access will continue for Albany Med Health System.
• The employee medical plans for Columbia Memorial Health are fully insured. Should an acceptable agreement not be reached, employees will receive more information from their campus about their own employee health plan.
• Employees of the Visiting Nurses Association and Staffing Alliance are not impacted by these negotiations. This employee medical plan is covered under Anthem effective January 1, 2025.
• Visiting Nurses Home Care (VNHC) employees remain with CDPHP for 2025 and may be impacted by network disruption.

The Albany Med Health System and CDPHP have agreed not to make any changes or decisions before Feb. 28, 2025.