Albany Med says it may be forced to drop CDPHP in 2025

ALBANY, N.Y. (NEWS10) -- The Albany Med Health System said it may be forced to no longer accept CDPHP as an insurance plan in 2025 due to an ongoing payment dispute. CDPHP reportedly owes Albany Med Health System about $50 million.

CDPHP, however, is alleging that Albany Med went public about the negotiations too quickly and inaccurately. They said it could "alarm and confuse" their members.

In October, Albany Med Heath System announced it was seeking legal action against CDPHP for allegedly withholding at least $50 million from Albany Medical Center for care it provided to CDPHP members. Since August 8, the insurance company reportedly failed to fully reimburse Albany Med on about 26,000 claims.

At that time, CDPHP officials told NEWS10 that the Medicare Wage Index changes resulted in an unfunded mandate for smaller regional health plans like theirs. They said the mandate would also result in $150 million in losses for CDPHP over the next two years.

“In order to protect the benefits and out-of-pocket health care costs paid by local seniors living on fixed incomes, the CDPHP board of directors – which is made of up local, practicing doctors – made the difficult decision to withhold these new payments to Albany Med Health System and St. Peter’s Health Partners. We do, however, continue to pay our hospital partners at the rates agreed to prior to this unfunded mandate being imposed by CMS,” CDPHP president and CEO Brian O’Grady said previously.

Albany Med Health System said they have still not received these payments from CDPHP and that's why they may need to remove them as an accepted plan. Officials noted that no official decision has been made, yet, but additional shortcomings are projected for 2025.

Albany Med said they are hoping to reach a resolution but are encouraging patients to consider other options.

“While we remain hopeful an agreement is reached, we must take the necessary steps to ensure patients are informed and access to the most critical care is preserved," said McKenna. "As the region’s only truly local health system, we strongly value our longstanding relationship with patients. We have to do everything we can to maintain the services they need most.”

The Albany Med Health System includes Albany Medical Center, Columbia Memorial Health, Glens Falls Hospital, and Saratoga Hospital. CDPHP members who receive care at these hospitals are getting sent a letter explaining the situation and what other insurance options are available if CDPHP becomes out-of-network.

Grady, the CDPHP CEO, responded, saying, “Unfortunately, the leadership of Albany Med has decided to take these negotiations public when both parties had committed to ongoing discussions. In addition to numerous factual inaccuracies in their statement, the actions by the leadership of Albany Med are in direct violation of the confidentiality agreement the parties entered into no more than 10 days ago while trying to amicably resolve this dispute. Their statement today is nothing more than a blatant attempt by a large hospital system to bully CDPHP and unnecessarily alarm our members and their patients. As a not-for-profit, community-based health plan, our focus is to ensure that our members are provided high quality health care at an affordable price. We find these actions unfortunate because they put you – the patients – in the middle of normal business discussions. Their actions today are nothing more than a shameful attempt to bully the health plan and alarm and confuse our members who are their patients.”

CDPHP said the contract termination date is Dec. 31 and there is a state mandated 60-day "cooling off" period where all members can continue to receive care at Albany Med Health System facilities until March 1, 2025.

If you are currently in an ongoing course of care, that period is extended for another 30 days. This will allow for additional weeks of negotiations, according to CDPHP.