As you may have heard, CDPHP is currently in discussions with Albany Med Health System (AMHS) regarding two separate issues.
2025 Contract
Discussions between CDPHP and Albany Med Health System (AMHS) have been productive, and we are making good progress toward a final agreement.
To ensure uninterrupted care for our members, we have mutually agreed to extend our current contract by one month, now in effect through March 31, 2025. For those in an ongoing course of care with an AMHS physician, that period is extended until April 30, 2025. Patients who are pregnant as of January 31, 2025, may continue seeing their provider until their baby is born and postpartum care is complete.
While we have this extension in place, we have every expectation of announcing our formal agreement in the very near future.
The Medicare Wage Index
While negotiations between hospitals and health plans are a normal part of business practices, our discussions are complicated by the fact that CDPHP and its competitors are facing financial hardship due to the Medicare wage index. This regulation granted hospitals in Upstate New York a windfall of $1 billion. Unfortunately, federal regulators failed to align private Medicare Advantage premiums with this adjustment, leaving CDPHP with a significant unfunded mandate that will result in nearly $145 million in losses over the next two years.
In the best interest of our members, particularly seniors on fixed incomes, CDPHP stopped paying this new, unfunded mandate in order to protect your benefits and out of pocket costs.
We do, however, continue to pay our hospital partners at the rates agreed to prior to this unfunded mandate. That means, your care is covered, and your claims are being paid.
We understand the critical nature of the services AMHS provides, and we are doing everything we can to retain them as part of our network.
Why is this happening?
Negotiations with hospitals and health plans are a normal part of our business practice. We use these discussions to advocate for you – our valued CDPHP members – to ensure you receive the highest quality of care at the most affordable price. It is unfortunate that AMHS has chosen to take these negotiations public, putting you in the middle.
What happens if an agreement is not reached?
CDPHP understands the value AMHS brings to our community, which is why we are working hard to reach an agreement and avoid any disruption in care for our members.
Members may continue to receive care at AMHS and its affiliates during the “cooling off” period through March 31, 2025. In addition, members who are in an ongoing course of care with an AMHS primary care physician or specialist may continue to receive care until April 30, 2025.
Members who are pregnant as of January 31, 2025, and seeing an AMHS doctor for pregnancy care can continue to see their provider until their baby is born and postpartum care is complete.
How do hospital costs affect me directly?
Today, 40 cents of every dollar you spend on health insurance goes directly to hospitals. As a good steward of your health care dollars, CDPHP feels strongly that it is our responsibility to advocate for lower hospital costs, which is why we are holding the line with AMHS.
Updated January 30, 2025