Thank you front liners

Providing Financial Relief

The coronavirus crisis is creating financial hardships for many, including our members and providers. Accordingly, we have taken steps to alleviate some of the financial burden of the pandemic.

Relief for Members

  • The COVID-19 crisis has had an immeasurable impact on all New Yorkers, particularly those on the front lines, such as health care workers, first responders, and all employees deemed essential. As such, the Department of Financial Services (DFS) has issued an emergency regulation removing all cost-share for essential employees seeking outpatient behavioral health care services with in-network providers. Effective May 2, 2020, this regulation has recently been extended through Friday, November 27, 2020.

    To ensure eligible members receive these services at no out-of-pocket cost, DFS is asking that providers ask each patient if they are an essential worker before collecting copayment. For a list of employees considered essential, visit the NYS DFS website. In lieu of other guidance, we ask that the modifier CR (“catastrophic/disaster-related”) be used when submitting a claim. In lieu of other guidance, we ask that the modifier CR (“catastrophic/disaster-related”) be used when submitting a claim.

    Cost-share for any medications subsequently prescribed will not be waived.

    The change affects all CDPHP commercial, Medicaid (although there is no cost-share for Medicaid), Child Health Plus, and Essential Plan members, as well as all self-funded ASO groups that have elected to waive cost-shares for essential employees. The change does not apply to CDPHP Medicare Advantage members or members of self-funded groups that did not choose to follow the mandate.

    Please note, the regulation does not apply to members enrolled in federally qualified health savings accounts (HSAs). For federally qualified plans that do not have an HSA, you must meet the deductible before CDPHP will waive any applicable co-insurance or copays.

    The emotional and psychological well-being of essential workers is critically important in the continuing fight against COVID-19. We thank you for your support.

    Podcast: Meeting Your Needs During the COVID-19 Pandemic

    To learn more about what CDPHP has done and is doing to meet the needs of its providers, members, and employees during the COVID-19 pandemic, we invite you to listen to this podcast by Dr. John Bennett, CDPHP president and CEO.

  • CDPHP members who seek medical care and/or testing for COVID-19 will be spared any cost-share for those services.*

  • CDPHP recognizes that members may have difficulty making on-time premium payments during this crisis. Grace periods for payment are in effect depending on a member’s coverage, and we have temporarily suspended termination notices for non-payment of premium pending additional guidance from state regulators.

  • A special enrollment period has been created for uninsured New York residents who are seeking health insurance coverage. Eligible individuals who enroll in coverage with CDPHP or through the New York State of Health Marketplace between March 16, 2020 and April 15, 2020 will have coverage effective April 1, 2020.

Relief for Providers

The cancellation of elective surgeries, routine cancer screenings, and other medical services have reduced the volume of patient visits for many medical practices. Fortunately, most of our primary care partners are on global payments from CDPHP, which keep their reimbursements level. But for those anticipating fee-for-service payments, the current crisis could lead to a reduction in cash flow.

  • CDPHP is monitoring our network’s financial viability closely. If you believe your practice is financially imperiled, please contact your provider relations specialist.

  • Under the recently enacted CARES Act, there are a number of loan, grant, and advanced payment provisions. Pay particular attention to the Paycheck Protection Program and SBA loan provisions.

  • On March 31, 2020, we sent you your physician withhold payment. This payment reflects a 100 percent return, and the check is payable on April 1, 2020.

  • We strongly recommend that you register now for electronic fund transfer (EFT) with CDPHP if you haven’t already enrolled. EFT payments are automatically transferred to your bank account, minimizing the risk of a delayed payment that could potentially happen with a paper check. You can easily register by following this step-by-step guide or contacting your provider relations representative.

*Note: Some CDPHP members belong to self-funded (ASO) groups that have unique requirements for medical service coverage during the COVID-19 crisis. You can verify coverage by contacting our provider services department at (518) 641-3500 (Monday through Friday, 7:30 a.m. to 5 p.m.).