ALBANT (NEWS10) - The Albany Med Health System (AMHS) is alleging that CDPHP, an Albany-based health insurer, owes the hospital more than $40 million. The organizations are in ongoing negotiations to resolve the reimbursement dispute and determine coverage terms for CDPHP members in 2025.
Dr. Dennis McKenna, CEO of Albany Med, said that reimbursements are essential for sustaining the hospital’s operations and unique services. “There’s care we deliver not only to CDPHP members but to the community that is very unique—children’s hospital services, trauma care, and advanced surgical procedures. We need to ensure reimbursements at least cover the cost of care”.
In a letter dated November 22, CDPHP addressed the situation: “AMHS has decided to take these negotiations public when both parties are committed to ongoing discussions. We find these actions unfortunate because they put you—the patients—in the middle of normal business discussions.”
Dr. McKenna countered the insurer's claim, saying Albany Med had no choice but to disclose the negotiations, “We have a moral and ethical obligation to inform the public as they make decisions about the insurance they will have in 2025".
In the letter send to members, CDPHP highlighted its own financial challenges, citing federal funding cuts to Medicare Advantage programs that the insurer expects will lead to $145 million in losses over the next two years. Albany Med has maintained that it continues to provide care to CDPHP members and has urged the insurer to fulfill its reimbursement obligations.
Greg Rinckey, an attorney based in Albany, noted the potential implications of the dispute during open enrollment. “Many people are concerned about whether their insurance will allow access to Albany Med services. At the same time, Albany Med is seeking payment for care already delivered,” he said.
Albany Med and CDPHP are scheduled to meet again on Friday. CDPHP has not provided additional comments on the negotiations. The discussions remain critical as patients navigate their insurance options and healthcare providers face mounting financial pressures.
