Insurance stress: CDPHP, St. Peter’s

I am experiencing some insurance stress based on two pieces of mail my wife and daughter received the same day last week. If you want to write a blues song after reading this, feel free.

The letter was from St. Peter’s Health Partners. It runs most of the city’s hospitals, clinics, and doctors’ offices that aren’t part of the Albany Medical Center. All of our primary care physicians are part of SPHP.

“Our records show that at the time of your last visit…, you… receive your health through a CDPHP commercial health plan.” CDPHP is the Capital District Community Health Plan. “Please be aware that [SPHP] has engaged in negotiations with CDPHP for a more equitable agreement to ensure we can continue to deliver high-quality, community-based care.”

Didn’t we do this dance a few years ago, which got resolved at the 11th hour?

In bold: “Our current agreement is set to expire effective January 1, 2023; meaning some patients may have increased financial responsibility when seeking care from [SPHP] in 2023 because CDPHP no longer includes the following facilities in its network.” Over a dozen facilities, including St. Peter’s Hospital, Samaritan Hospital, and five Eddy facilities, are on the list. Interestingly, no related mail from CDPHP has arrived.

On the coverage

Meanwhile, my wife and my daughter also received a Benefits Bulletin from my former employer, the Research Foundation for The State University of New York, or SUNY RF. “If you are a retiree or an eligible dependent of a retiree and you are not eligible for Medicare, your current RF benefits will continue for 2023 unless you make changes during open enrollment.” That window is November 1-30.

Just in case we need to make a change, I went to the SUNY RF portal to see if I could find the forms to change their coverage, but none of them seemed appropriate. Some were for the retiree (me), while some were for the retiree and dependents. I am on a different plan for administrative reasons.

So I called the SUNY RF number on Monday and then a different one on Wednesday. I was offered the same form to make changes, even though it didn’t make sense to me. If I change my wife and daughter to a Blue Cross program, I hope SUNY RF does not muck it up.

CVS

Meanwhile, a good friend of mine writes on Facebook: “We’ve…just been notified by [CDPHP] that CVS will no longer take our prescription insurance effective 1/1/2023… This is very upsetting because CVS is very convenient to where we live, has a drive-through, and the closest to our house is one of the only 24-hour pharmacies in the Capital District.” We got no such letter from CDPHP.

I called my local CVS pharmacist. They said that CVS has declined to take the CDPHP price schedule, so it may very well cost more to fill prescriptions there, but they won’t really know until they start filling them next year.

This issue will be a primary concern of mine this month because I can’t wait until the CDPHP/SPHP issue gets resolved in December if, in fact, it does.

Author: Roger

I'm a librarian. I hear music, even when it's not being played. I used to work at a comic book store, and it still informs my life. I won once on JEOPARDY! - ditto. View all posts by Roger